Diabetes doubles risk for heart failure

Recent clinical trials of new glucose-lowering treatments have drawn attention to the importance of hospitalization for heart failure as a complication of diabetes mellitus. The study, led by Sarah Wild from the University of Glasgow on behalf of the Scottish Diabetes Research Network examined health data of 3.25 million people from January 2004 to December 2013. It looked at the incidence rate for heart failure hospitalisation and any deaths that resulted for 30 days following that admittance to hospital.

Heart failure hospitalization incidence was higher in people with diabetes mellitus (at least 1.78-fold), regardless of type, than in people without. The study also found that patients with Type 1 diabetes were more likely to die as a result of heart failure, in comparison with patients with type 2 diabetes and those without diabetes.

Despite this, patients with Type 1 diabetes were prescribed fewer drugs that are used to treat and prevent heart failure. More work is now needed to see if people with type 1 diabetes would benefit from greater use of drugs for preventing cardiovascular disease.

“Heart failure incidence has fallen over time for people with and without diabetes,“ said lead author David McAllister, “but it is still around two times higher in people with diabetes than in people without diabetes. Our findings suggest that heart failure is an under-recognised and important complication in diabetes, particularly for type 1 disease.”

Overall, the differences in risk of heart failure death were large; compared to women without diabetes, women with type 1 diabetes had around a 2.5-fold higher risk of having a heart failure admission which results in death within 30-days. For the equivalent comparison in men, there is almost a 4-fold difference in risk. The researchers said they would expect that among men aged 50 to 69 with type 2 diabetes, 1.1 in 1,000 would have a heart failure admission resulting in death, compared to only 0.2 per 1,000 in men the same age without diabetes. 

Recent reports suggest that certain diabetes meds can lower the incidence of heart failure. In November, cardiologists at Boston-based Brigham and Women's Hospital reported that dapagliflozin, a SGLT-2 inhibitor developed by British AstraZeneca, markedly reduced the risk of hospitalisation for heart failure in a broad population of patients with diabetes.