Jackson, A. M. et al. (2022) Diabetes and pre‐diabetes in patients with heart failure and preserved ejection fraction. European Journal of Heart Failure, 24(3), pp. 497-509. (doi: 10.1002/ejhf.2403) (PMID:34918855) (PMCID:PMC9542636)
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Abstract
Aim: There is an association between heart failure with preserved ejection fraction (HFpEF) and insulin resistance, but less is known about the diabetic continuum, and in particular about pre-diabetes, in HFpEF. We examined characteristics and outcomes of participants with diabetes or pre-diabetes in PARAGON-HF. Methods and results: Patients aged ≥50 years with left ventricular ejection fraction ≥45%, structural heart disease and elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) were eligible. Patients were classified according to glycated haemoglobin (HbA1c): (i) normal HbA1c, <6.0%; (ii) pre-diabetes, 6.0%–6.4%; (iii) diabetes, ≥6.5% or history of diabetes. The primary outcome was a composite of cardiovascular (CV) death and total heart failure hospitalizations (HFH). Of 4796 patients, 50% had diabetes and 18% had pre-diabetes. Compared to patients with normal HbA1c, patients with pre-diabetes and diabetes more often were obese, had a history of myocardial infarction and had lower Kansas City Cardiomyopathy Questionnaire scores, while patients with diabetes had more clinical evidence of congestion, but similar NT-proBNP concentrations. The risks of the primary composite outcome (rate ratio [RR] 1.59, 95% confidence interval [CI] 1.35–1.88), total HFH (RR 1.67, 95% CI 1.39–2.02) and CV death (hazard ratio [HR] 1.35, 95% CI 1.07–1.71) were higher among patients with diabetes, compared to those with normal HbA1c. Patients with pre-diabetes had a higher risk (which was intermediate between that of patients with diabetes and those with normal HbA1c) of the primary outcome (HR 1.27, 95% CI 1.00–1.60) and HFH (HR 1.35, 95% CI 1.03–1.77), but not of CV death (HR 1.02, 95% CI 0.75–1.40). Patients with diabetes treated with insulin had worse outcomes than those not, and those with ‘lean diabetes’ had similar mortality rates to those with a higher body mass index, but lower rates of HFH. Conclusion: Pre-diabetes is common in patients with HFpEF and is associated with worse clinical status and greater risk of HFH. Clinical Trial Registration: ClinicalTrials.gov Identifier NCT01920711.
Item Type: | Articles |
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Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Cleland, Professor John and Jackson, Dr Alice and Jhund, Professor Pardeep and McMurray, Professor John and Petrie, Professor Mark |
Authors: | Jackson, A. M., Rørth, R., Liu, J., Kristensen, S. L., Anand, I. S., Claggett, B. L., Cleland, J. G.F., Chopra, V. K., Desai, A. S., Ge, J., Gong, J., Lam, C. S.P., Lefkowitz, M. P., Maggioni, A. P., Martinez, F., Packer, M., Pfeffer, M. A., Pieske, B., Redfield, M. M., Rizkala, A. R., Rouleau, J. L., Seferović, P. M., Tromp, J., Van Veldhuisen, D. J., Yilmaz, M. B., Zannad, F., Zile, M. R., Køber, L., Petrie, M. C., Jhund, P. S., Solomon, S. D., and McMurray, J. J.V. |
Subjects: | R Medicine > R Medicine (General) |
College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre |
Journal Name: | European Journal of Heart Failure |
Publisher: | Wiley |
ISSN: | 1388-9842 |
ISSN (Online): | 1879-0844 |
Published Online: | 17 December 2021 |
Copyright Holders: | Copyright © 2021 The Authors |
First Published: | First published in European Journal of Heart Failure 24(3): 497-509 |
Publisher Policy: | Reproduced under a Creative Commons License |
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