Diabetes linked to substantial risk of left-sided valvular stenotic lesions

Sweden: A nationwide registry-based analysis reported that patients with type 1 and 2 diabetes are at higher risk for left-sided valvular stenotic lesions, whereas the risk for valvular regurgitation was significantly lower in type 2 diabetes. The article was published in the Circulation.

Diabetes is a major public health problem and is approaching epidemic proportions globally. It dramatically increases the risk of various cardiovascular problems. Four heart valves serve to make the blood go in the right direction. Studies have shown that individuals with diabetes display a substantially increased risk of disease in left-sided heart valves since the pressure is highest on the left side of the heart. Valve (valvular) disease can cause many problems, such as labored breathing, fatigue, dizziness, and at worst heart failure. The role of diabetes in the development of valvular heart disease and particularly the relationship with risk factor control has not been extensively studied till now.

Araz Rawshani, University of Gothenburg, Sweden, and colleagues conducted an analysis study to investigate the long-term trends for left-sided degenerative valvular heart disease, in a large cohort of patients with diabetes.

Investigators included 715,143 patients with diabetes registered in the Swedish National Diabetes Register and compared them with 2,732,333 matched controls randomly selected from the general population. Trends were analyzed with incidence rates and Cox regression, which was also used to assess diabetes as a risk factor compared to controls, and, second, separately in patients with diabetes according to the presence of five risk factors. ( HbA1c, Systolic, and diastolic blood pressure, Albuminuria, Smoking, and LDL-C )

The study findings showed that,

• The incidence of valvular disease was found to increase over time.

• In patients with T2D, systolic BP, BMI, and renal function were factors strongly associated with the incidence of valvular disease.

• Patients with T2D experienced a higher risk of stenotic lesions (HR, 1.34 for aortic stenosis) but had a lower risk of regurgitant lesions (HR, 0.67 for aortic regurgitation), regardless of optimal risk-factor control.

• T1D was also found to be associated with a substantially increased risk of valvular stenosis (HR, 2.01 for aortic stenosis).

Investigators concluded that diabetes is associated with a higher risk for left-sided valvular stenotic lesions, but a significantly lower risk for valvular regurgitation. The study findings also suggested that patients with well-controlled cardiovascular risk factors are at a higher risk for valvular stenosis, without a clear stepwise decrease in risk between various degrees of risk factor control.

Reference:

The study titled, "Left-Sided Degenerative Valvular Heart Disease in Type 1 and Type 2 Diabetes," was published in the journal Circulation. 

DOI: https://doi.org/10.1161/CIRCULATIONAHA.121.058072