Microvascular Disease and Incident Heart Failure Among Individuals With Type 2 Diabetes Mellitus
Background Microvascular disease (MVD) is a potential contributor to the pathogenesis of diabetes mellitus–related cardiac dysfunction. However, there is a paucity of data on the link between MVD and incident heart failure (HF) in type 2 diabetes mellitus. We examined the association of MVD with inc...
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| Format: | Article |
| Language: | English |
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Wiley
2021-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.018998 |
| _version_ | 1819182723018784768 |
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| author | Arnaud D. Kaze Prasanna Santhanam Sebhat Erqou Rexford S. Ahima Alain Bertoni Justin B. Echouffo‐Tcheugui |
| author_facet | Arnaud D. Kaze Prasanna Santhanam Sebhat Erqou Rexford S. Ahima Alain Bertoni Justin B. Echouffo‐Tcheugui |
| author_sort | Arnaud D. Kaze |
| collection | DOAJ |
| description | Background Microvascular disease (MVD) is a potential contributor to the pathogenesis of diabetes mellitus–related cardiac dysfunction. However, there is a paucity of data on the link between MVD and incident heart failure (HF) in type 2 diabetes mellitus. We examined the association of MVD with incident HF in adults with type 2 diabetes mellitus. Methods and Results A total of 4095 participants with type 2 diabetes mellitus and free of HF were assessed for diabetes mellitus–related MVD including nephropathy, retinopathy, or neuropathy at baseline in the Look AHEAD (Action for Health in Diabetes) study. Incident HF events were prospectively assessed and adjudicated using hospital and death records. Cox models were used to generate hazard ratios and 95% CIs for HF. Of 4095 participants, 34.8% (n=1424) had MVD, defined as the presence of ≥1 of nephropathy, retinopathy, or neuropathy at baseline. Over a median of 9.7 years, there were 117 HF events. After adjusting for relevant confounders, participants with MVD had a 2.5‐fold higher risk of incident HF than those without MVD (hazard ratio, 2.54; 95% CI, 1.73–3.75). This association remained significant after additional adjustment for interval development of coronary artery disease (hazard ratio, 2.42; 95% CI, 1.64–3.57). The hazard ratios for HF by type of MVD were 2.22 (95% CI, 1.51–3.27), 1.30 (95% CI, 0.72–2.36), and 1.33 (95% CI, 0.86–2.07) for nephropathy, retinopathy, and neuropathy, respectively. CONCLUSIONS MVD is associated with an excess HF risk in individuals with type 2 diabetes mellitus after adjusting for other known risk factors. Our findings underscore the contribution of MVD to the development of diabetes mellitus–related HF. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00017953. |
| first_indexed | 2024-12-22T22:50:39Z |
| format | Article |
| id | doaj.art-a54c3d80d91a486087c87ba5ee279549 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T22:50:39Z |
| publishDate | 2021-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-a54c3d80d91a486087c87ba5ee2795492022-12-21T18:09:58ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-06-01101210.1161/JAHA.120.018998Microvascular Disease and Incident Heart Failure Among Individuals With Type 2 Diabetes MellitusArnaud D. Kaze0Prasanna Santhanam1Sebhat Erqou2Rexford S. Ahima3Alain Bertoni4Justin B. Echouffo‐Tcheugui5Department of Medicine University of Maryland Medical Center Baltimore MDDivision of Endocrinology, Diabetes & Metabolism Johns Hopkins School of Medicine Baltimore MDDepartment of Medicine Providence VA Medical Center and Alpert Medical School of Brown University Providence RIDivision of Endocrinology, Diabetes & Metabolism Johns Hopkins School of Medicine Baltimore MDDepartment of Epidemiology and Prevention Wake Forest University School of Medicine Winston‐Salem NCDivision of Endocrinology, Diabetes & Metabolism Johns Hopkins School of Medicine Baltimore MDBackground Microvascular disease (MVD) is a potential contributor to the pathogenesis of diabetes mellitus–related cardiac dysfunction. However, there is a paucity of data on the link between MVD and incident heart failure (HF) in type 2 diabetes mellitus. We examined the association of MVD with incident HF in adults with type 2 diabetes mellitus. Methods and Results A total of 4095 participants with type 2 diabetes mellitus and free of HF were assessed for diabetes mellitus–related MVD including nephropathy, retinopathy, or neuropathy at baseline in the Look AHEAD (Action for Health in Diabetes) study. Incident HF events were prospectively assessed and adjudicated using hospital and death records. Cox models were used to generate hazard ratios and 95% CIs for HF. Of 4095 participants, 34.8% (n=1424) had MVD, defined as the presence of ≥1 of nephropathy, retinopathy, or neuropathy at baseline. Over a median of 9.7 years, there were 117 HF events. After adjusting for relevant confounders, participants with MVD had a 2.5‐fold higher risk of incident HF than those without MVD (hazard ratio, 2.54; 95% CI, 1.73–3.75). This association remained significant after additional adjustment for interval development of coronary artery disease (hazard ratio, 2.42; 95% CI, 1.64–3.57). The hazard ratios for HF by type of MVD were 2.22 (95% CI, 1.51–3.27), 1.30 (95% CI, 0.72–2.36), and 1.33 (95% CI, 0.86–2.07) for nephropathy, retinopathy, and neuropathy, respectively. CONCLUSIONS MVD is associated with an excess HF risk in individuals with type 2 diabetes mellitus after adjusting for other known risk factors. Our findings underscore the contribution of MVD to the development of diabetes mellitus–related HF. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00017953.https://www.ahajournals.org/doi/10.1161/JAHA.120.018998heart failuremicrovascular diseasetype 2 diabetes mellitus |
| spellingShingle | Arnaud D. Kaze Prasanna Santhanam Sebhat Erqou Rexford S. Ahima Alain Bertoni Justin B. Echouffo‐Tcheugui Microvascular Disease and Incident Heart Failure Among Individuals With Type 2 Diabetes Mellitus Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease heart failure microvascular disease type 2 diabetes mellitus |
| title | Microvascular Disease and Incident Heart Failure Among Individuals With Type 2 Diabetes Mellitus |
| title_full | Microvascular Disease and Incident Heart Failure Among Individuals With Type 2 Diabetes Mellitus |
| title_fullStr | Microvascular Disease and Incident Heart Failure Among Individuals With Type 2 Diabetes Mellitus |
| title_full_unstemmed | Microvascular Disease and Incident Heart Failure Among Individuals With Type 2 Diabetes Mellitus |
| title_short | Microvascular Disease and Incident Heart Failure Among Individuals With Type 2 Diabetes Mellitus |
| title_sort | microvascular disease and incident heart failure among individuals with type 2 diabetes mellitus |
| topic | heart failure microvascular disease type 2 diabetes mellitus |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.018998 |
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