Research
Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital
Published

Diabetes status-related differences in risk factors and mediators of heart failure in the general population: results from the MORGAM/BiomarCaRE consortium

Research output: Contribution to journalJournal articleResearchpeer-review

  1. Distinct non-ischemic myocardial late gadolinium enhancement lesions in patients with type 2 diabetes

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Blood pressure and mortality in patients with type 2 diabetes and a recent coronary event in the ELIXA trial

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Fibroblast growth factor-23 is associated with imaging markers of diabetic cardiomyopathy and anti-diabetic therapeutics

    Research output: Contribution to journalJournal articleResearchpeer-review

  1. The age-specific incidence of type 2 diabetes in Danish elderly adults – the role of size at birth

    Research output: Contribution to conferenceConference abstract for conferenceResearchpeer-review

  2. FGL1 as a modulator of plasma D-dimer levels: exome-wide marker analysis of plasma tPA, PAI-1 and D-dimer

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Response to Roldan et al

    Research output: Contribution to journalLetterResearchpeer-review

  • Matti A Vuori
  • Jaakko Reinikainen
  • Stefan Söderberg
  • Ellinor Bergdahl
  • Pekka Jousilahti
  • Hugh Tunstall-Pedoe
  • Tanja Zeller
  • Dirk Westermann
  • Susana Sans
  • Allan Linneberg
  • Licia Iacoviello
  • Simona Costanzo
  • Veikko Salomaa
  • Stefan Blankenberg
  • Kari Kuulasmaa
  • Teemu J Niiranen
View graph of relations

BACKGROUND: The risk of heart failure among diabetic individuals is high, even under tight glycemic control. The correlates and mediators of heart failure risk in individuals with diabetes need more elucidation in large population-based cohorts with long follow-up times and a wide panel of biologically relevant biomarkers.

METHODS: In a population-based sample of 3834 diabetic and 90,177 non-diabetic individuals, proportional hazards models and mediation analysis were used to assess the relation of conventional heart failure risk factors and biomarkers with incident heart failure.

RESULTS: Over a median follow-up of 13.8 years, a total of 652 (17.0%) and 5524 (6.1%) cases of incident heart failure were observed in participants with and without diabetes, respectively. 51.4% were women and the mean age at baseline was 48.7 (standard deviation [SD] 12.5) years. The multivariable-adjusted hazard ratio (HR) for heart failure among diabetic individuals was 2.70 (95% confidence interval, 2.49-2.93) compared to non-diabetic participants. In the multivariable-adjusted Cox models, conventional cardiovascular disease risk factors, such as smoking (diabetes: HR 2.07 [1.59-2.69]; non-diabetes: HR 1.85 [1.68-2.02]), BMI (diabetes: HR 1.30 [1.18-1.42]; non-diabetes: HR 1.40 [1.35-1.47]), baseline myocardial infarction (diabetes: HR 2.06 [1.55-2.75]; non-diabetes: HR 2.86 [2.50-3.28]), and baseline atrial fibrillation (diabetes: HR 1.51 [0.82-2.80]; non-diabetes: HR 2.97 [2.21-4.00]) had the strongest associations with incident heart failure. In addition, biomarkers for cardiac strain (represented by nT-proBNP, diabetes: HR 1.26 [1.19-1.34]; non-diabetes: HR 1.43 [1.39-1.47]), myocardial injury (hs-TnI, diabetes: HR 1.10 [1.04-1.16]; non-diabetes: HR 1.13 [1.10-1.16]), and inflammation (hs-CRP, diabetes: HR 1.13 [1.03-1.24]; non-diabetes: HR 1.29 [1.25-1.34]) were also associated with incident heart failure. In general, all these associations were equally strong in non-diabetic and diabetic individuals. However, the strongest mediators of heart failure in diabetes were the direct effect of diabetes status itself (relative effect share 43.1% [33.9-52.3] and indirect effects (effect share 56.9% [47.7-66.1]) mediated by obesity (BMI, 13.2% [10.3-16.2]), cardiac strain/volume overload (nT-proBNP, 8.4% [-0.7-17.4]), and hyperglycemia (glucose, 12.0% [4.2-19.9]).

CONCLUSIONS: The findings suggest that the main mediators of heart failure in diabetes are obesity, hyperglycemia, and cardiac strain/volume overload. Conventional cardiovascular risk factors are strongly related to incident heart failure, but these associations are not stronger in diabetic than in non-diabetic individuals. Active measurement of relevant biomarkers could potentially be used to improve prevention and prediction of heart failure in high-risk diabetic patients.

Original languageEnglish
Article number195
JournalCardiovascular Diabetology
Volume20
Issue number1
Pages (from-to)195
ISSN1475-2840
DOIs
Publication statusPublished - 28 Sep 2021

Bibliographical note

© 2021. The Author(s).

ID: 68335231