Diabetes mellitus and risk of new‐onset and recurrent heart failure: a systematic review and meta‐analysis

Abstract

Despite mounting evidence of the positive relationship between diabetes mellitus (DM) and heart failure (HF), the entire context of the magnitude of risk for HF in relation to DM remains insufficiently understood. The principal reason is because new-onset HF (HF occurring in participants without a history of HF) and recurrent HF (HF re-occurring in patients with a history of HF) are not discriminated. This meta-analysis aims to comprehensively and separately assess the risk of new-onset and recurrent HF depending on the presence or absence of DM. We systematically searched cohort studies that examined the relationship between DM and new-onset or recurrent HF using EMBASE and MEDLINE (from 1 Jan 1950 to 28 Jul 2019). The risk ratio (RR) for HF in individuals with DM compared with those without DM was pooled with a random-effects model. Seventy-four and 38 eligible studies presented data on RRs for new-onset and recurrent HF, respectively. For new-onset HF, the pooled RR [95% confidence interval (CI)] of 69 studies that examined HF as a whole [i.e. combining HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF)] was 2.14 (1.96-2.34). The large between-study heterogeneity (I 2 = 99.7%, P < 0.001) was significantly explained by mean age [pooled RR (95% CI) 2.60 (2.38-2.84) for mean age < 60 years vs. pooled RR (95% CI) 1.95 (1.79-2.13) for mean age ≥ 60 years] (P < 0.001). Pooled RRs (95% CI) of seven and eight studies, respectively, that separately examined HFpEF and HFrEF risk were 2.22 (2.02-2.43) for HFpEF and 2.73 (2.71-2.75) for HFrEF. The risk magnitudes between HFpEF and HFrEF were not significantly different in studies that examined both HFpEF and HFrEF risks (P = 0.86). For recurrent HF, pooled RR (95% CI) of the 38 studies was 1.39 (1.33-1.45). The large between-study heterogeneity (I 2 = 80.1%, P < 0.001) was significantly explained by the proportion of men [pooled RR (95% CI) 1.53 (1.40-1.68) for < 65% men vs. 1.32 (1.25-1.39) for ≥65% men (P = 0.01)] or the large pooled RR for studies of only participants with HFpEF [pooled RR (95% CI), 1.73 (1.32-2.26) (P = 0.002)]. Results indicate that DM is a significant risk factor for both new-onset and recurrent HF. It is suggested that the risk magnitude is large for new-onset HF especially in young populations and for recurrent HF especially in women or individuals with HFpEF. DM is associated with future HFpEF and HFrEF to the same extent.

Diabetes Mellitus and Heart Failure

“…The risk magnitudes between HFpEF and HFrEF were not significantly different in studies that examined the risk in both syndromes (p = 0.86), whereas for recurrent HF, the pooled RR (95% CI) of 38 studies was 1.39 (1.33-1.45). These data indicate that, in patients with DM, the magnitude of risk for new-onset HF and recurrent HF is large and DM is associated with a high incidence of both HFpEF and HFrEF [9].…”

Ischemic Etiology and Prognosis in Men and Women with Acute Heart Failure

“…It is possible that high blood pressure plays a less prominent role in the development of ischemic heart disease in women, which would be more related to other cardiovascular risk factors, such as diabetes [ 23 , 26 ]. HF risk is higher in women with diabetes than in men with diabetes [ 23 , 26 , 27 , 28 ]. Analyzing the characteristics of women with ischemic etiology, we have observed that the clinical profile of these patients is more similar to men with ischemic HF than to women with HF of non-ischemic etiology, suggesting that several differences associated with sex might be, in fact, related to ischemic etiology.…”

Indicațiile actuale ale combinației terapeutice sacubitril/valsartan în insuficiența cardiacă | [Current indications for sacubitril/valsartan therapeutic combination in heart failure]

“…Prin urmare, pe lângă reducerea morbidității și mortalității în IC-FES, terapia cu sacubitril/ valsartan ar putea oferi beneficii metabolice suplimentare la pacienții cu diabet zaharat. În plus, aceste date ar putea sugera că pacienții cu diabet zaharat care primesc sacubitril/ valsartan pentru tratamentul IC ar putea necesita ajustarea dozei de terapie hipoglicemiantă (Kodama et al, 2020).…”