Elderly Patients With T2D, Heart Failure Have High Risk for Mortality

Heart failure, among other cardiovascular complications, is associated with increased mortality among elderly patients with type 2 diabetes, according to findings from a multicenter, prospective, observational study published in Diabetes Care.

Investigators of this study recruited a total of 987 elderly participants with type 2 diabetes from 56 medical centers throughout a 1-year period. Patients were followed for up to 5 years to determine associations between cardiovascular complications and survival. Coronary heart disease and vascular disease of the lower limbs and cerebral vessels were the most frequent cardiovascular complications in this cohort.

The frequency of heart failure in this patient population was lower than that of other complications; however, heart failure doubled at 5 years compared with baseline (9% to 20%). Heart failure was found to be significantly associated with high mortality (P <.0001). In addition, vascular disease of the lower limbs was also associated with poor survival (P =.0004) at 5-year follow-up.

Associations between poor survival outcomes and vascular disease of cerebral vessels (P =.026) and coronary heart disease (P =.0056) were observed. Following a multivariate analysis, the investigators determined that heart failure represented the strongest predictor of mortality compared with other complications (hazard ratio [HR] 1.96; 95% CI, 1.45-2.64; P <.0001). This association persisted when researchers considered other factors occurring simultaneously with heart failure (HR 1.92; 95% CI, 1.43-2.58; P <.0001).

Approximately 13.3% of patients were lost to follow-up, which potentially reduces the power of these findings. Additionally, the researchers did not control for medications the patients were taking throughout the study period, and these medications could have played a role in survival outcomes.

Despite these limitations, the findings suggest that physicians should not underestimate “the importance of coronary heart disease in patients with type 2 diabetes” in relation to survival outcomes. Elderly people with type 2 diabetes and heart failure may be at particularly high risk and should be managed accordingly.

Reference

Bauduceau B, Le Floch JP, Halimi S, Verny C, Doucet J; SFD/SFGG Intergroup. Cardiovascular complications over 5 years, and their association with survival in the GERODIAB cohort of elderly French patients with type 2 diabetes [published online November 7, 2017]. Diabetes Care. doi:10.2337/dc17-1437