Excess Risk of Hospitalization for Heart Failure Among People With Type 2 Diabetes
abstract
This abstract is available on the publisher's site.
Access this abstract nowAIMS/HYPOTHESIS
Type 2 diabetes is an established risk factor for heart failure, but age-specific data are sparse. We aimed to determine excess risk of heart failure, based on age, glycaemic control and kidney function in comparison with age- and sex-matched control individuals from the general population.
METHODS
Individuals with type 2 diabetes registered in the Swedish National Diabetes Registry 1998-2012 (n = 266,305) were compared with age-, sex- and county-matched control individuals without diabetes (n = 1,323,504), and followed over a median of 5.6 years until 31 December 2013.
RESULTS
We identified 266,305 individuals with type 2 diabetes (mean age 62.0 years, 45.3% women) and 1,323,504 control individuals. Of the individuals with type 2 diabetes and control individuals, 18,715 (7.0%) and 50,157 (3.8%) were hospitalised with a diagnosis of heart failure, respectively. Comparing individuals with diabetes with those in the control group, men and women with type 2 diabetes who were younger than 55 years of age had HRs for hospitalisation for heart failure of 2.07 (95% CI 1.73, 2.48) and 4.59 (95% CI 3.50, 6.02), respectively, using analyses adjusted for socioeconomic variables and associated conditions. Younger age, poorer glycaemic control and deteriorating renal function were all associated with increased excess risk of heart failure in those with type 2 diabetes compared with the control group. However, people with diabetes who were ≥75 years and without albuminuria or with good glycaemic control (HbA1c ≤52 mmol/mol [≤6.9%]) had a similar risk of hospitalisation for heart failure as control individuals in the same age group.
CONCLUSIONS/INTERPRETATION
Men and women aged <55 years with type 2 diabetes are at markedly elevated excess risk of heart failure. The excess risk declined with age, but persisted even with good glycaemic control. However, among those who were 75 years and older, diabetic individuals with well controlled glucose levels or without albuminuria had a risk of heart failure that was on a par with individuals without diabetes.
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Additional Info
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Excess Risk of Hospitalisation for Heart Failure Among People With Type 2 Diabetes
Diabetologia 2018 Nov 01;61(11)2300-2309, A Rosengren, J Edqvist, A Rawshani, N Sattar, S Franzén, M Adiels, AM Svensson, M Lind, S GudbjörnsdottirFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The current study is a large observational study of over 250,000 individuals with diabetes and over 1 million controls from Sweden from a national data repository. Diabetes was associated with a significantly increased risk of heart failure, with important observations about subgroups of patients at even higher risk than others, including younger patients with poor glycemic control. These data are quite relevant and timely given the recent revelation of marked improvements in heart failure hospitalizations in patients with type 2 diabetes at increased risk for cardiovascular outcomes studied in the published EMPA-REG and CANAVAS programs.1-3 Marked ~40% reductions in hospitalization for heart failure were observed with SGLT2 inhibitors in the two trials, including subgroups with or without prior heart failure and in patients with and without known coronary artery disease. The precise mechanism(s) of benefit with these agents is unclear. Leveraging data from large observational registries like that presented by Rosengren and colleagues in combination with data from rigorous clinical trials is needed to better understand the heart failure risk, identify groups at greatest risk, and promote better understanding of mechanisms and treatment options.