Heart failure in type 2 diabetes: An impending reality
From diminished quality of life1 to increased mortality,2 the burden of HF is an impending reality for many patients with type 2 diabetes (T2D).3
Diabetes is a major risk factor for the development of HF.4 Patients with T2D are at an increased risk for HF, compared to those without T2D.5 The reality is, up to 50% of patients with T2D may develop HF.3
HF in T2D by the numbers
The risk of HF may start earlier than you might suspect in your patients with T2D.6
HF is one of the most common first comorbidities in patients with T2D. In a multinational registry including 772,336 patients with T2D with no history of cardiovascular disease or chronic kidney disease, HF was the first comorbidity in 24% of patients.7
For patients with T2D, HF is a more common first CV complication than either myocardial infarction (MI) or stroke.8
In fact, 68% of patients with T2D showed signs of left ventricular (LV) dysfunction within just five years of diabetes diagnosis in the absence of inducible ischemia.6†
Even people with prediabetes show evidence of heart damage that may be associated with heart failure.9‡
HF is going undiagnosed in T2D
Among patients with T2D, there is a high prevalence of undiagnosed HF. In one study, 28% of patients with T2D were found to have previously undiagnosed HF.10§
The cardio-renal link in T2D
Primary disorders of the heart or kidney often result in secondary dysfunction or injury to the other.
The heart and kidney are inextricably linked11
Kidney damage in T2D may start earlier than you may suspect – up to one in four patients with T2D had microalbuminuria at initial diagnosis.12|| Nearly 40% of patients with T2D have microalbuminuria.13
Microalbuminuria has been associated with 3x higher incidence rate of overall HF compared to those without microalbuminuria over a five year period.14#
The impact of HF in T2D
With their increased risk for HF, patients with T2D also have a statistically greater risk for related hospitalisation15 and death.2
Patients with T2D have a 33% higher change of hospitalisation for HF than those without T2D.15**
On average, in the United States the cost of HF-related hospitalisation is approximately $23,000.16††
A grim prognosis
One study found that almost 50% of T2D patients who develop HF will die in five years.2‡‡
In fact, the 5-year risk of mortality in T2D patients who developed HF was 3 times higher than that of T2D patients without cardiovascular and renal disease.2
†Prospective, multicenter study, evaluating clinical and echocardiographic characteristics of individuals with T2D (n=386) who were determined to be free from cardiac disease. Mean age of study population was 69 years. Mean duration of diabetes was 5 years; mean A1C was 7.1%. LVD comprised of the combined asymptomatic left ventricular systolic and/or diastolic dysfunction.6
‡Prediabetes defined as A1C of 5.7% to 6.4%. Heart damage as measured by elevated cardiac troponin T (≥14 ng/L).9
§In a cross-sectional study to assess the prevalence of unknown heart failure in 581 patients with T2D (≥60 years).10
||In a Dutch study of 195 screening-detected patients with T2D and 60 newly diagnosed diabetes in general practice, prevalence of microalbuminuria (ACR >2.0 mg/mmol) was 17.2% and 26.7%, respectively.12
#Data from a study of patients with and without T2D. Of 2912 individuals with UACR, there were 122 (5.0%) heart failure events in individuals without microalbuminuria and 70 (14.0%) events among those with microalbuminuria (15+/-4 years of follow-up; 12.7 vs 3.6 events per 1000 person-years). UACR defined as ≥17 mg/g in men and ≥25 mg/g in women.14
**Based on a 4-year analysis of 45,227 patients from the international REACH registry.15
††Based on 23,216 hospitalisations for heart failure among patients aged 18-64 from the 2005 MarketScan Commercial Claims and Encounters inpatient data set.16
‡‡Based on a Danish national patient registry study from 1998 – 2015 involving 153,403 newly diagnosed T2D patients. 5-year risk of death among patients alive 5 years after T2D diagnosis, 47.6% [95% CI, 44.8–50.3] 2
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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(7):e006260. .
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- Faden G, Faganello G, De Feo S, et al. The increasing detection of asymptomatic left ventricular dysfunction in patients with type 2 diabetes mellitus without overt cardiac disease: data from the SHORTWAVE study. Diabetes Res Clin Pract. 2013;101(3):309-316.
- Birkeland KI, Bodegard J, Eriksson JW, et al. Heart failure and chronic kidney disease manifestation and mortality risk associations in type 2 diabetes: A large multinational cohort study. Diabetes Obes Metab. 2020;22(9):1607-1618.
- Shah AD, Langenberg C, Rapsomaniki E, et al. Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1.9 million people. Lancet Diabetes Endocrinol. 2015;3(2):105-113.
- Selvin E, Lazo M, Chen Y, et al. Diabetes mellitus, prediabetes, and incidence of subclinical myocardial damage. Circulation. 2014;130(16):1374-1382.
- Boonman-de Winter LJ, Rutten FH, Cramer MJ, et al. High prevalence of previously unknown heart failure and left ventricular dysfunction in patients with type 2 diabetes. Diabetologia. 2012;55(8):2154-2162.
- Ronco C, Haapio M, House AA, et al. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52(19):1527-1539.
- Spijkerman AM, Dekker JM, Nijpels G, et al. Microvascular complications at time of diagnosis of type 2 diabetes are similar among diabetic patients detected by targeted screening and patients newly diagnosed in general practice: the Hoorn screening study. Diabetes Care. 2003;26:2604-2608.
- Parving HH, Brenner BM, McMurray JJ, et al. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N Engl J Med. 2012;367(23):2204-2213.
- Nayor M, Larson MG, Wang N, et al. The association of chronic kidney disease and microalbuminuria with heart failure with preserved vs. reduced ejection fraction. Eur J Heart Fail. 2017;19(5):615-623.
- Cavender MA, Steg G, Smith SC, et al. Impact of diabetes mellitus on hospitalisation for heart failure, cardiovascular events, and death: outcomes at 4 years from the Reduction of Atherothrombosis for Continued Health (REACH) registry. Circulation. 2015;132(10):923-931.
- Wang G, Zhang Z, Ayala C, et al. Costs of heart failure-related hospitalisations in patients aged 18-64 years. Am J Manag Care. 2010;16(10):769-776.