Diabetes Worsens CV Outcomes in HF, Severity Depends on Microvascular Complications

Diabetes and microvascular complications are associated with adverse outcomes among individuals with heart failure with preserved ejection fraction (HFpEF), according to a recent study.

For their study, the researchers evaluated 3385 patients with HFpEF who were enrolled in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial (TOPCAT). Of these patients, 49% were men and 89% were white. Mean patient age was 69 years.
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Self-reported history and medical record review were used to assess diabetes and microvascular complications, including neuropathy, nephropathy, and retinopathy. Outcomes were hospitalization, hospitalization for heart failure, mortality, and cardiovascular mortality.

A total of 1109 (32%) patients had diabetes, of whom 352 (32%) also had at least 1 microvascular complication. Results indicated that patients with diabetes and microvascular complications had a higher risk for hospitalization, hospitalization for heart failure, mortality, and cardiovascular mortality.

Among 2449 participants who had reported prior hospitalization for heart failure, the researchers also observed an increased risk for rehospitalization in those with no diabetes, diabetes and no microvascular complications, or diabetes and microvascular complications.

“Diabetes is associated with adverse cardiovascular outcomes in HFpEF, and the inherent risk of adverse outcomes in HFpEF patients with diabetes varies by the presence of microvascular complications,” the researchers concluded.

—Christina Vogt

Reference:

Sandesara PB, O’Neal WT, Kelli HM, et al. The prognostic significance of diabetes and microvascular complications in patients with heart failure with preserved ejection fraction [Published online October 19, 2017]. Diabetes Care. https://doi.org/10.2337/dc17-0755.