TY - JOUR
T1 - Prevalence and Prognostic Implications of Diabetes With Cardiomyopathy in Community-Dwelling Adults
AU - Segar, Matthew W.
AU - Khan, Muhammad Shahzeb
AU - Patel, Kershaw V.
AU - Butler, Javed
AU - Tang, W. H.Wilson
AU - Vaduganathan, Muthiah
AU - Lam, Carolyn S.P.
AU - Verma, Subodh
AU - McGuire, Darren K.
AU - Pandey, Ambarish
N1 - Funding Information:
This study was supported an investigator-initiated research grant by Applied Therapeutics to UT Southwestern Medical Center, Dallas, Texas (principal investigator Dr. Pandey). The sponsors had no role in the study design, conduct, or manuscript preparation. Dr Segar has received nonfinancial support from Pfizer and Merck. Dr Butler is a consultant to Abbott, Adrenomed, Amgen, Applied Therapeutics, Array, AstraZeneca, Bayer, Boehringer Ingelheim, Cardior, CVRx, G3 Pharma, Impulse Dynamics, Innolife, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novartis, NovoNordisk, Relypsa, Roche, Sanofi, Sequana Medical, and Vifor. Dr Tang has served as a consultant for Sequana Medical AG, Relypsa, PreCardia, Cardiol Therapeutics Inc, Genomics Plc, and Owkin Inc; and has served as an exam writing committee member for American Board of Internal Medicine. Dr Vaduganathan has received research grant support or served on advisory boards for American Regent, Amgen, AstraZeneca, Bayer AG, Baxter Healthcare, Boehringer Ingelheim, Cytokinetics, Lexicon Pharmaceuticals, and Relypsa; and has participated on clinical endpoint committees for studies sponsored by Galmed, Novartis, and the National Institutes of Health. Dr Lam has received grant support and advisory board fees from Boston Scientific and Roche Diagnostics; has received grant support, advisory board fees, and fees for serving on a steering committee from AstraZeneca; has received grant support from Medtronic; has received grant support and fees for serving on a steering committee from Vifor Pharma; has received advisory board fees and fees for serving on a steering committee from Novartis; has received advisory board fees from Amgen, Boehringer Ingelheim, Abbott Diagnostics, Novo Nordisk, Biofourmis, and MyoKardia; has received consulting fees from Stealth BioTherapeutics, Jana Care, Darma, Cytokinetics, WebMD Global, Radcliffe Group, and Corpus; has received fees for serving on a steering committee from Janssen Research and Development, Corvia Medical, and Applied Therapeutics; has received lecture fees and consulting fees from Menarini Group; holds a pending patent PCT/SG2016/050217 on a method for the diagnosis and prognosis of chronic heart failure; holds a pending patent 16/216,929 on an automatic clinical workflow that recognizes and analyzes 2-dimensional and Doppler modality echocardiography; and has received fees for serving as cofounder and nonexecutive director of eko.ai. Dr McGuire has had leadership roles in clinical trials for AstraZeneca, Boehringer Ingelheim, Eisai, Esperion, GlaxoSmithKline, Janssen, Lexicon, Merck and Co Inc, Novo Nordisk, CSL Behring, Lilly, USA and Sanofi USA; and has received consultancy fees from AstraZeneca, Boehringer Ingelheim, Lilly USA, Merck and Co Inc, Pfizer, Novo Nordisk, Metavant, Afimmune, Bayer, and Sanofi. Dr Pandey has served on the advisory board of Roche Diagnostics; has received nonfinancial support from Pfizer and Merck; and has received research support from the Texas Health Resources Clinical Scholarship, the Gilead Sciences Research Scholar Program, the National Institute on Aging GEMSSTAR Grant (1R03AG067960-01), Myovista, and Applied Therapeutics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2021 The Authors
PY - 2021/10/19
Y1 - 2021/10/19
N2 - Background: Diabetes is associated with abnormalities in cardiac remodeling and high risk of heart failure (HF). Objectives: The purpose of this study was to evaluate the prevalence and prognostic implications of diabetes with cardiomyopathy (DbCM) among community-dwelling individuals. Methods: Adults without prevalent cardiovascular disease or HF were pooled from 3 cohort studies (ARIC [Atherosclerosis Risk In Communities], CHS [Cardiovascular Health Study], CRIC [Chronic Renal Insufficiency Cohort]). Among participants with diabetes, DbCM was defined using different definitions: 1) least restrictive: ≥1 echocardiographic abnormality (left atrial enlargement, left ventricle hypertrophy, diastolic dysfunction); 2) intermediate restrictive: ≥2 echocardiographic abnormalities; and 3) most restrictive: elevated N-terminal pro–B-type natriuretic peptide levels (>125 in normal/overweight or >100 pg/mL in obese) plus ≥2 echocardiographic abnormalities. Adjusted Fine-Gray models were used to evaluate the risk of HF. Results: Among individuals with diabetes (2,900 of 10,208 included), the prevalence of DbCM ranged from 67.0% to 11.7% in the least and most restrictive criteria, respectively. Higher fasting glucose, body mass index, and age as well as worse kidney function were associated with higher risk of DbCM. The 5-year incidence of HF among participants with DbCM ranged from 8.4%-12.8% in the least and most restrictive definitions, respectively. Compared with euglycemia, DbCM was significantly associated with higher risk of incident HF with the highest risk observed for the most restrictive definition of DbCM (HR: 2.55 [95% CI: 1.69-3.86]; least restrictive criteria HR: 1.99 [95% CI: 1.50-2.65]). A similar pattern of results was observed across cohort studies, across sex and race subgroups, and among participants without hypertension or obesity. Conclusions: Regardless of the criteria used to define cardiomyopathy, DbCM identifies a high-risk subgroup for developing HF.
AB - Background: Diabetes is associated with abnormalities in cardiac remodeling and high risk of heart failure (HF). Objectives: The purpose of this study was to evaluate the prevalence and prognostic implications of diabetes with cardiomyopathy (DbCM) among community-dwelling individuals. Methods: Adults without prevalent cardiovascular disease or HF were pooled from 3 cohort studies (ARIC [Atherosclerosis Risk In Communities], CHS [Cardiovascular Health Study], CRIC [Chronic Renal Insufficiency Cohort]). Among participants with diabetes, DbCM was defined using different definitions: 1) least restrictive: ≥1 echocardiographic abnormality (left atrial enlargement, left ventricle hypertrophy, diastolic dysfunction); 2) intermediate restrictive: ≥2 echocardiographic abnormalities; and 3) most restrictive: elevated N-terminal pro–B-type natriuretic peptide levels (>125 in normal/overweight or >100 pg/mL in obese) plus ≥2 echocardiographic abnormalities. Adjusted Fine-Gray models were used to evaluate the risk of HF. Results: Among individuals with diabetes (2,900 of 10,208 included), the prevalence of DbCM ranged from 67.0% to 11.7% in the least and most restrictive criteria, respectively. Higher fasting glucose, body mass index, and age as well as worse kidney function were associated with higher risk of DbCM. The 5-year incidence of HF among participants with DbCM ranged from 8.4%-12.8% in the least and most restrictive definitions, respectively. Compared with euglycemia, DbCM was significantly associated with higher risk of incident HF with the highest risk observed for the most restrictive definition of DbCM (HR: 2.55 [95% CI: 1.69-3.86]; least restrictive criteria HR: 1.99 [95% CI: 1.50-2.65]). A similar pattern of results was observed across cohort studies, across sex and race subgroups, and among participants without hypertension or obesity. Conclusions: Regardless of the criteria used to define cardiomyopathy, DbCM identifies a high-risk subgroup for developing HF.
KW - diabetes with cardiomyopathy
KW - heart failure
KW - pre-diabetes
KW - type 2 diabetes mellitus
UR - http://www.scopus.com/inward/record.url?scp=85116317398&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85116317398&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2021.08.020
DO - 10.1016/j.jacc.2021.08.020
M3 - Article
C2 - 34649696
AN - SCOPUS:85116317398
VL - 78
SP - 1587
EP - 1598
JO - Journal of the American College of Cardiology.
JF - Journal of the American College of Cardiology.
SN - 0735-1097
IS - 16
ER -