Heart Failure Linked to Highest Mortality Risk in Patients With Recent Type 2 Diabetes

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3d rendered illustration of a man with chest pain.
Patients with type 2 diabetes have a greater risk for death after development of heart failure compared with other cardiovascular or renal diagnoses.

Patients with a recent type 2 diabetes (T2D) diagnosis have a greater risk for death after development of heart failure (HF) compared with other cardiovascular or renal diagnoses. These results from a nationwide study were published in Circulation: Cardiovascular Quality and Outcomes.

Patients with a new diagnosis of T2D (N=153,403) with no history of HF were identified from Danish nationwide health registers between 1998 and 2015. These patients were followed for a median of 9.7 years (interquartile range [IQR], 5.8-13.9 years) to estimate 5-year risk ratios (RRs) for mortality after developing cardiovascular and/or renal complications.

At the time of inclusion, the patients had a median age of 64.0 years (IQR, 55-72 years). In total, 10.9% of patients had hypertension at inclusion, 3.9% had cancer, 3.2% had atrial fibrillation, and 2.4% had chronic obstructive pulmonary disease. Patients were prescribed angiotensin-converting enzyme or angiotensin 2 receptor blockers (41.7%), statins (34.4%), acetylic salicylic acid (23.7%), calcium channel blockers (22.3%), beta blockers (21.5%), thiazide (20.2%), loop diuretics (13.4%), and mineralocorticoid receptor antagonists (3.7%).

During the study, 45.1% of patients had a cardiovascular or renal diagnosis. Of these patients, 62.3% had 1 cardiovascular or renal diagnosis, 25.0% had 2 diagnoses, and 12.6% had 3 or more diagnoses. The most frequently diagnosed condition was ischemic heart disease and HF was the least frequent. A total of 48,087 patients died during the study.

At 5 years after their T2D diagnosis, the RR of patient death due to HF was 3 times higher (95% CI, 2.9-3.1) compared with that in patients without any incident cardiovascular or renal disease. The risk for mortality was lower in patients with other conditions, including peripheral artery disease (RR, 2.3; 95% CI, 2.3-2.4), stroke (RR, 2.2; 95% CI, 2.1-2.2), chronic kidney disease (RR, 1.7; 95% CI, 1.7-1.8), and ischemic heart disease (RR, 1.3; 95% CI, 1.3-1.4).

Compared with individuals who did not develop cardiovascular or renal disease, the decrease in lifespan within 5 years for patients with a single diagnosis was highest for HF (11.7 months; 95% CI, 11.6-11.8), followed by peripheral artery disease (6.9 months; 95% CI, 6.8-7.0), stroke (6.4 months; 95% CI, 6.3-6.5), chronic kidney disease (4.4 months; 95% CI, 4.3-4.6), and ischemic heart disease (1.6 months; 95% CI, 1.5-1.7).

The investigators conducted stratified analyses according to year of inclusion, sex, age, and comorbidities at inclusion and found that HF was consistently linked to the greatest risk for mortality, both alone and in combination with chronic kidney disease, peripheral artery disease, and stroke.

A limitation of this study was that no information was available about heart rate, blood pressure, or biochemical features that may have affected the likelihood of developing HF.

The study authors concluded that within 5 years of a T2D diagnosis, HF was the most infrequent but also the most fatal condition, regardless of an additional cardiovascular or renal diagnosis. “[W]e hope that our findings contribute to assessing risk profiles and prognosis, especially concerning the importance of evaluating patients with T2D regularly for HF,” noted the researchers.

Disclosure: Multiple study authors declared affiliations with industry. Please refer to the original reference for a full list of disclosures.

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Zareini B, Blanche P, D’Souza M, et al. Type 2 diabetes mellitus and impact of heart failure on prognosis compared to other cardiovascular diseases: a nationwide study. Circ Cardiovasc Qual Outcomes. 2020;13:e006260.