Microvascular complications in diabetes patients with heart failure and reduced ejection fraction—insights from the Beta‐blocker Evaluation of Survival Trial

Abstract

In HFrEF, diabetes with microvascular complications is associated with worse symptoms and outcomes than diabetes without microvascular complications. Prevention of microvascular complications has the potential to improve HFrEF outcomes.

Prognostic implications of microvascular complications in patients with diabetes and heart failure with reduced ejection fraction

“…The group with diabetes and microvascular complications also had more severe functional limitations defined by New York Heart Association classification and worse quality of life assessed by the Minnesota Living with Heart Failure Questionnaire. Kristensen and colleagues concluded that microvascular complications in individuals with diabetes and HFrEF provide important prognostic information …”

“…In conclusion, Kristensen and colleagues provide evidence that microvascular complications are important prognostic markers in patients with diabetes and HFrEF . While the evidence supporting the role of diabetes‐related microvascular complications in the causal pathway of adverse CV events is less clear, they are important contributors to the morbidity burden in this patient population.…”

“…In this issue of the Journal, Kristensen and colleagues evaluated whether microvascular complications in patients with diabetes and HF with reduced ejection fraction (HFrEF) were associated with increased risk of adverse clinical outcomes in the Beta-blocker Evaluation of Survival Trial (BEST), a clinical trial of individuals with HFrEF who were randomized to receive either bucindolol or placebo. 9 Of the 2707 study participants from BEST, individuals were divided into three groups based on the presence of diabetes and, for individuals with diabetes, the presence of microvascular complications, specifically, neuropathy, retinopathy, or nephropathy. Approximately one-third of patients with HFrEF and diabetes had microvascular complications, of which neuropathy was the most common.…”

November 2018 at a glance: from prediction of heart failure in asymptomatic subjects to advanced chronic heart failure

“…Kristensen et al . analysed 2707 patients with HF and reduced EF (HFrEF) from BEST (Beta‐blocker Evaluation of Survival Trial).…”

“…Similar results were found for mortality. Thus, the presence of microvascular complications identifies HFrEF diabetic patients with the highest risk of poor outcomes …”