Diabetes with cardiomyopathy tied to higher risk of heart failure: JACC
USA: According to a recent study in the Journal of the American College of Cardiology (JACC), the prevalence of diabetes with cardiomyopathy (DbCM) among diabetes patients varies from ∼12% to ∼67% depending on the criteria used with more restrictive criteria being related to a lower prevalence. However, regardless of the criteria used diabetes patients with cardiomyopathy are at a significantly higher risk of developing heart failure (HF).
Type 2 diabetes is a chronic condition that affects approx 462 million individuals worldwide and according to WHO, the prevalence is expected to increase. Cardiovascular disease (CVD) is the leading cause of death among diabetes patients. Heart failure accounts for a large proportion of initial CVD presentations in diabetes.
Against the above background, Matthew W. Segar, Parkland Health and Hospital System, Dallas, Texas, USA, and colleagues aimed to evaluate the prevalence and prognostic implications of DbCM among community-dwelling individuals.
For this purpose, the researchers pooled adults without prevalent cardiovascular disease or HF from 3 cohort studies (ARIC [Atherosclerosis Risk In Communities], CHS [Cardiovascular Health Study], CRIC [Chronic Renal Insufficiency Cohort]). Among diabetes patients DbCM was defined using different definitions: 1) least restrictive: ≥1 echocardiographic abnormality (left atrial enlargement, left ventricle hypertrophy, diastolic dysfunction); 2) intermediate restrictive: ≥2 echocardiographic abnormalities; and 3) most restrictive: elevated N-terminal pro–B-type natriuretic peptide levels (>125 in normal/overweight or >100 pg/mL in obese) plus ≥2 echocardiographic abnormalities.
The study revealed the following findings:
- Among individuals with diabetes (2,900 of 10,208 included), the prevalence of DbCM ranged from 67.0% to 11.7% in the least and most restrictive criteria, respectively.
- Higher fasting glucose, body mass index, and age as well as worse kidney function were associated with higher risk of DbCM.
- The 5-year incidence of HF among participants with DbCM ranged from 8.4%-12.8% in the least and most restrictive definitions, respectively.
- Compared with euglycemia, DbCM was significantly associated with higher risk of incident HF with the highest risk observed for the most restrictive definition of DbCM (HR: 2.55; least restrictive criteria HR: 1.99).
- A similar pattern of results was observed across cohort studies, across sex and race subgroups, and among participants without hypertension or obesity.
"Regardless of the criteria used to define cardiomyopathy, DbCM identifies a high-risk subgroup for developing HF," wrote the authors. "Future studies are needed to evaluate whether targeted prescription of effective therapies among patients with DbCM can reduce the risk of HF."
Reference:
The study titled, "Prevalence and Prognostic Implications of Diabetes With Cardiomyopathy in Community-Dwelling Adults," is published in the Journal of the American College of Cardiology (JACC)
DOI: https://www.jacc.org/doi/10.1016/j.jacc.2021.08.020
