TOPLINE:

In patients with type 2 diabetes (T2D) without prior cardiovascular disease (CVD), heart failure (HF) accounted for 16.8% of first major CV events. The occurrence of HF was more strongly associated with older age, higher BMI, and increased albuminuria ― a set of risk factors distinct from those associated with initial atherosclerotic CVD (ASCVD) events. 

METHODOLOGY:

• HF can develop independently in patients with T2D without prior CVD; however, existing risk stratification methods may overlook a significant portion of these cases.
• Researchers conducted a post hoc analysis of data from two clinical trials to examine the proportion of first-ever CVD events that were attributed to HF, as opposed to ASCVD or other CVDs in 6175 patients (mean age, 64 years; 50.1% women) with T2D and no history of prior CVD.
• They monitored the first major CV event, defined as the earliest occurrence of HF (hospitalization for HF or CV death with HF), an ASCVD event (acute coronary syndrome, stroke, or revascularization procedure), or other CV death (due to causes excluding myocardial infarction, stroke, or HF).
• The median follow-up duration was 5.8 years.

TAKEAWAY:

• During follow-up, 1024 (16.6%) patients experienced a first major CV event; ASCVD was most common (65.2%), followed by other CV deaths (18.0%), and HF (16.8%).
• Older age, higher BMI, and higher urine albumin-to-creatinine ratios were associated with greater odds of CVD manifesting first as HF than as ASCVD or other CV death.
• Higher low-density lipoprotein cholesterol levels, increased A1c levels, and higher systolic blood pressure were associated with increased odds of CVD that presented first as ASCVD.
• The probability of HF presenting as the first CV event ranged from 5.1% in individuals with a profile enriched with ASCVD-specific risk factors at age 55 years to 32.0% in those with a profile enriched with HF-specific risk factors at age 75 years.

IN PRACTICE:

“HF events were observed as the first major CVD events in a sufficiently large proportion of people with [T2D] that HF should not be overlooked in primary prevention. Importantly, this CVD subtype has unique risk factors, which raises the prospect of differentiating its likelihood from CVD that presents first as an ASCVD event,” the authors wrote.

SOURCE:

This study was led by Julian W. Sacre, PhD, Baker Heart and Diabetes Institute, Melbourne, Australia. It was published online in Diabetes, Obesity and Metabolism.

LIMITATIONS:

The study could not differentiate between HF subtypes, such as preserved vs reduced ejection fraction. The analysis drew from two CV outcomes trials that prioritized ASCVD risk in participant selection. Additionally, combining data from two trials conducted a decade apart may have introduced data harmonization issues. 

DISCLOSURES:

This study was supported by the National Health and Medical Research Council of Australia and the Victorian Government’s Operational Infrastructure Support Program. The trials were sponsored by Eli Lilly and Company and Sanofi. Some authors reported receiving grants, funding, consulting fees, or honoraria from various pharmaceutical companies. One author reported holding shares in Novo Nordisk, and another reported holding a leadership position and a patent.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.