Study proves diabetes is an independent predictor of HF

A cross-structural analysis published in Mayo Clinic Proceedings this January independently links diabetes to the development of heart failure, suggesting diabetic cardiomyopathy (DCM) is a real—and growing—issue in the U.S.

The study, penned by Michael D. Klajda, MD, and colleagues at the Mayo Clinic, sought to clarify the relationship between heart failure and diabetes mellitus (DM), which remains the seventh leading cause of death in the United States and is known to hike a patient’s risk of coronary artery disease, stroke, atherosclerosis and hypertension. Patients with diabetes represent around one-third of HF admissions in the country.

Klajda et al. define DCM as a myocardial disease secondary to diabetic microangiography or abnormal myocardial metabolism in DM leading to cardiomegaly and HF. In other words, diabetic cardiomyopathy is the development of primary HF stemming from the metabolic disease itself.

“Recently, studies have shown that even without signs of overt structural heart disease or HF, patients with DM with preclinical diastolic dysfunction were more likely to develop HF and have higher rates of mortality compared with those with DM without diastolic function,” the authors wrote. “Due to the concurrent presence of hypertension and coronary heart disease in many patients with DM, the incidence of HF and DCM due to DM is not well-defined.”

The team enrolled their study population at random through the Rochester Epidemiology Project. All patients were at least 45 years old at the study’s baseline, and 2,042 responders assessed participants’ systolic and diastolic function using echocardiography.

Klajda and colleagues’ analysis included 116 participants with diabetes, who were matched 1:2 with a group of 232 non-diabetic patients for age, sex, hypertension and coronary artery disease. People with DM tended to have higher BMIs and higher plasma insulin and serum glucose levels than their non-DM counterparts, though left ventricular ejection fractions were similar between groups.

The authors noted a higher incidence of heart failure in patients with diabetes—more than double the rate of that in non-diabetic patients after 10 years of follow-up. Subjects with DM also demonstrated an average 10-year Kaplan-Meier rate of 21% compared to non-DM patients’ 12%.

In a subgroup analysis of participants without diastolic dysfunction, Klajda and co-authors said those with DM saw a 2.5-fold increased risk for heart failure compared to their peers.

“The findings in this report support the concept of diabetic cardiomyopathy,” the authors wrote. “Future research should be focused on whether aggressive management of risk factors such as BMI and glucose and cholesterol levels will decrease the development of HF in patients with DM.”

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