TY - JOUR
T1 - Optimal cardiometabolic health and risk of heart failure in type 2 diabetes
T2 - an analysis from the Look AHEAD trial
AU - Patel, Kershaw V.
AU - Khan, Muhammad Shahzeb
AU - Segar, Matthew W.
AU - Bahnson, Judy L.
AU - Garcia, Katelyn R.
AU - Clark, Jeanne M.
AU - Balasubramanyam, Ashok
AU - Bertoni, Alain G.
AU - Vaduganathan, Muthiah
AU - Farkouh, Michael E.
AU - Januzzi, James L.
AU - Verma, Subodh
AU - Espeland, Mark
AU - Pandey, Ambarish
N1 - Funding Information:
The Look AHEAD Trial was funded by the National Institutes of Health through cooperative agreements with the National Institute of Diabetes and Digestive and Kidney Diseases: DK57136 DK57149 DK56990 DK57177 DK57171 DK57151 DK57182 DK57131 DK57002 DK57078 DK57154 DK57178 DK57219 DK57008 DK57135 and DK56992. Additional funding was provided by the National Heart, Lung, and Blood Institute; National Institute of Nursing Research; National Center on Minority Health and Health Disparities; NIH Office of Research on Women's Health; and the Centers for Disease Control and Prevention. This research was supported in part by the Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases. This work was partially supported by a NORC Center Grant P30DK072476 and Louisiana Clinical and Translational Science Center grant U54 GM104940. The Indian Health Service provided personnel, medical oversight, and use of facilities. The opinions expressed in this article are those of the authors and do not necessarily reflect the views of the Indian Health Service or other funding sources. Additional support was received from the Johns Hopkins Medical Institutions Bayview General Clinical Research Center (M01RR02719); the Massachusetts General Hospital Mallinckrodt General Clinical Research Center and the Massachusetts Institute of Technology General Clinical Research Center (M01RR01066); the Harvard Clinical and Translational Science Center (RR025758‐04); the University of Colorado Health Sciences Center General Clinical Research Center (M01RR00051) and Clinical Nutrition Research Unit (P30 DK48520); the University of Tennessee at Memphis General Clinical Research Center (M01RR0021140); the University of Pittsburgh General Clinical Research Center (M01RR000056), the Clinical Translational Research Center funded by the Clinical & Translational Science Award (UL1 RR 024153) and a National Institutes of Health grant (DK 046204); the VA Puget Sound Health Care System Medical Research Service, Department of Veterans Affairs; and the Frederic C. Bartter General Clinical Research Center (M01RR01346). The following organizations have committed to make major contributions to Look AHEAD: FedEx Corp; Health Management Resources; LifeScan, Inc, a Johnson & Johnson Company; OPTIFAST of Nestle HealthCare Nutrition, Inc; Hoffmann‐La Roche Inc; Abbott Nutrition; and Slim‐Fast Brand of Unilever North America. Some of the information contained herein was derived from data provided by the Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene.
Publisher Copyright:
© 2022 European Society of Cardiology.
PY - 2022/11
Y1 - 2022/11
N2 - Aims: To evaluate the contribution of baseline and longitudinal changes in cardiometabolic health (CMH) towards heart failure (HF) risk among adults with type 2 diabetes (T2D). Methods and results: Participants of the Look AHEAD trial with T2D and without prevalent HF were included. Adjusted Cox models were used to create a CMH score incorporating target levels of parameters weighted based on relative risk for HF. The associations of baseline and changes in the CMH score with risk of overall HF, HF with preserved (HFpEF) and reduced ejection fraction (HFrEF) were assessed using Cox models. Among the 5080 participants, 257 incident HF events occurred over 12.4 years of follow-up. The CMH score included 2 points each for target levels of waist circumference, glomerular filtration rate, urine albumin-to-creatinine ratio, and 1 point each for blood pressure and glycated haemoglobin at target. High baseline CMH score (6–8) was significantly associated with lower overall HF risk (adjusted hazard ratio [HR], ref = low score (0–3): 0.31, 95% confidence interval [CI] 0.21–0.47) with similar associations observed for HFpEF and HFrEF. Improvement in CMH was significantly associated with lower risk of overall HF (adjusted HR per 1-unit increase in score at 4 years: 0.80, 95% CI 0.70–0.91). In the ACCORD validation cohort, the baseline CMH score performed well for predicting HF risk with adequate discrimination (C-index 0.70), calibration (chi-square 5.53, p = 0.70), and risk stratification (adjusted HR [high (6–8) vs. low score (0–3)]: 0.35, 95% CI 0.26–0.46). In the Look AHEAD subgroup with available biomarker data, incorporating N-terminal pro-B-type natriuretic peptide to the baseline CMH score improved model discrimination (C-index 0.79) and risk stratification (adjusted HR [high (8–10) vs. low score (0–4)]: 0.18, 95% CI 0.09–0.35). Conclusions: Achieving target levels of more CMH parameters at baseline and sustained improvements were associated with lower HF risk in T2D.
AB - Aims: To evaluate the contribution of baseline and longitudinal changes in cardiometabolic health (CMH) towards heart failure (HF) risk among adults with type 2 diabetes (T2D). Methods and results: Participants of the Look AHEAD trial with T2D and without prevalent HF were included. Adjusted Cox models were used to create a CMH score incorporating target levels of parameters weighted based on relative risk for HF. The associations of baseline and changes in the CMH score with risk of overall HF, HF with preserved (HFpEF) and reduced ejection fraction (HFrEF) were assessed using Cox models. Among the 5080 participants, 257 incident HF events occurred over 12.4 years of follow-up. The CMH score included 2 points each for target levels of waist circumference, glomerular filtration rate, urine albumin-to-creatinine ratio, and 1 point each for blood pressure and glycated haemoglobin at target. High baseline CMH score (6–8) was significantly associated with lower overall HF risk (adjusted hazard ratio [HR], ref = low score (0–3): 0.31, 95% confidence interval [CI] 0.21–0.47) with similar associations observed for HFpEF and HFrEF. Improvement in CMH was significantly associated with lower risk of overall HF (adjusted HR per 1-unit increase in score at 4 years: 0.80, 95% CI 0.70–0.91). In the ACCORD validation cohort, the baseline CMH score performed well for predicting HF risk with adequate discrimination (C-index 0.70), calibration (chi-square 5.53, p = 0.70), and risk stratification (adjusted HR [high (6–8) vs. low score (0–3)]: 0.35, 95% CI 0.26–0.46). In the Look AHEAD subgroup with available biomarker data, incorporating N-terminal pro-B-type natriuretic peptide to the baseline CMH score improved model discrimination (C-index 0.79) and risk stratification (adjusted HR [high (8–10) vs. low score (0–4)]: 0.18, 95% CI 0.09–0.35). Conclusions: Achieving target levels of more CMH parameters at baseline and sustained improvements were associated with lower HF risk in T2D.
KW - Cardiometabolic health
KW - Heart failure
KW - Type 2 diabetes mellitus
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U2 - 10.1002/ejhf.2723
DO - 10.1002/ejhf.2723
M3 - Article
C2 - 36280384
AN - SCOPUS:85143715791
SN - 1388-9842
VL - 24
SP - 2037
EP - 2047
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
IS - 11
ER -