The effect of metabolic dysfunction-associated fatty liver disease and diabetic kidney disease on the risk of hospitalization of heart failure in type 2 diabetes: a retrospective cohort study

Abstract

Background Diabetes mellitus is a major risk factor for heart failure. A recent consensus statement recommended annual cardiac biomarker testing (e.g. natriuretic peptide or high-sensitivity cardiac troponin) for all patients with diabetes. We aimed to identify patients at a higher risk of hospitalization for heart failure among patients with type 2 diabetes to prioritize those who would require screening. Methods Overall, 1,189,113 patients who underwent two medical health checkup cycles (2009–2012 and 2011–2014) and had stable diabetic kidney disease (DKD) phenotype in the Korean National Health Insurance Service database were included in this study. After excluding those with concurrent proteinuria (PU) and reduced estimated glomerular filtration rate, three groups (no-DKD, PU+DKD, and PU−DKD) were identified. A fatty liver index of ≥ 60 was defined as metabolic dysfunction–associated fatty liver disease (MAFLD). Patients were followed up until December 2018 or until outcomes developed. The Cox proportional hazard model was used to compare the risk of hospitalization for heart failure across groups. Results During an average of 6.6 years of follow-up, 5781 patients developed hospitalization for heart failure. After adjusting for covariates, the risk of hospitalization for heart failure was highest in the PU+DKD group [HR 3.12, 95% CI (2.75–3.55)], followed by the PU−DKD group [HR 1.85, 95% CI (1.73–1.99)] using the no-DKD group as the reference category. The risk of hospitalization for heart failure was comparable regardless of MAFLD status in patients who already had DKD. However, in the no-DKD group, the risk of hospitalization for heart failure was 1.4 times higher in patients with MAFLD than in those without [HR 1.41, 95% CI (1.31–1.52)]. Conclusions In lines with the international consensus statement, we suggest that annual cardiac biomarker testing should be conducted at least in patients with DKD and/or MAFLD.

Biomarker for cardiorenal syndrome risk in patients with liver cirrhosis and type 2 diabetes in Saudi Arabia

“… 38 , 39 Moreover, previous research reported that the CRS association was dependent on hypertriglyceridemia and oxidative stress. 40 Lee et al 41 observed that proteinuria and renal dysfunction were risk enhancers for hospitalization for HF in T2DM patients, which was in line with previous studies. 42 Also, in patients without proteinuria and decreased eGFR, MAFLD significantly increased the risk of hospitalization for HF, signifying that active diagnostic and interventional policies should be available for T2DM patients, minimally in those who concurrently have diabetic kidney disease or MAFLD.…”

Salvianolic acid B ameliorates myocardial fibrosis in diabetic cardiomyopathy by deubiquitinating Smad7

“…Cardiac fibroblasts (CFs) are one of the main effectors in fibrotic scar formation in the heart, owing to their role in ECM turnover [ 8 ]. When myocardial fibrosis occurs, CFs proliferation, migration, phenotypic transformation, and collagen secretion significantly increase [ 9 , 10 ]. The differentiation of CFs into myofibroblasts is a crucial process in myocardial fibrosis, with α-smooth muscle actin (α-SMA) considered a marker of myofibroblast differentiation [ 11 ].…”