Impact of diabetes and sex in heart failure with reduced ejection fraction patients from the ASIAN‐HF registry

Abstract

Aims To examine sex differences in clinical characteristics, echocardiographic features, quality of life and 1‐year death or heart failure (HF) hospitalization outcomes in patients with/without diabetes mellitus (DM). Methods and results Utilizing the Asian Sudden Cardiac Death in HF (ASIAN‐HF) registry, 5255 patients (mean age 59.6 ± 13.1, 78% men) with symptomatic HF with reduced ejection fraction (HFrEF) were stratified by DM status to address the research aims. Despite similar prevalence of DM between Asian men (43%) and women (42%), the odds of DM increased at lower body mass index in women vs. men (≥ 23 vs. ≥ 27.5 kg/m2, Pinteraction = 0.014). DM was more strongly related to chronic kidney disease in women vs. men [adjusted odds ratio (OR) 1.85, 95% confidence interval (CI) 1.33–2.57 vs. OR 1.32, 95% CI 1.11–1.56, Pinteraction = 0.009]. Sex also modified the relationship between DM and left ventricular geometry (Pinteraction = 0.003), whereby DM was associated with a more concentric left ventricular geometry in women than men. Women had lower quality of life than men (P < 0.001), in both DM and non‐DM groups. DM was associated with worse composite outcomes at 1 year in women vs. men [hazard ratio (HR) 1.79, 95% CI 1.24–2.60 vs. HR 1.32, 95% CI 1.12–1.56; Pinteraction = 0.005). Conclusions Asian women with HFrEF were more likely to have DM despite a lean body mass index, a greater burden of chronic kidney disease and more concentric left ventricular geometry, compared to men. Furthermore, DM confers worse quality of life, irrespective of sex, and a greater risk of adverse outcomes in women than men. These data underscore the need for sex‐specific approaches to diabetes in patients with HF.

March 2019 at a glance: epidemiology and clinical trials

“…Asian patients have different characteristics compared with Western ones . Chandramouli et al . examined the interaction of sex and diabetes in 5255 patients enrolled in the Asian Sudden Cardiac Death in HF (ASIAN‐HF) registry.…”

Sex hormones in heart failure revisited?

“…In this issue of the Journal, the paper by Chandramouli et al . addresses this issue and provides new insight into the relationship between diabetes mellitus (DM) and sex in HFrEF patients from the ASIAN‐HF registry.…”

“…They found that Asian women with HFrEF were more likely to have DM and more concentric left ventricular geometry compared to men. Furthermore, DM confers worse quality of life and a greater risk of adverse outcomes in women than men . Among HF patients, DM is a common co‐morbidity and confers worse prognosis .…”

“…If ischaemic HF was excluded, how would be the results? It would have been interesting to evaluate by sensitive analysis if ischaemic aetiology was a significant modifier of the relationship between DM and outcomes . If the relationships between DM and outcomes had been affected by ischaemic aetiology, it would have been likely that ischaemia, rather than diabetes, would have been the main variable affecting outcomes.…”

“…Second, the cause of mortality should be considered to understand the results from the ASIAN‐HF registry . Because many HFrEF patients with ischaemic aetiology were included, the prevalence of death due to acute coronary syndrome might have been higher.…”