Spotlight on heart failure and diabetes

Recent studies looked at the risk of heart failure among patients with diabetes and the potential to prevent this comorbidity.

A study published by Diabetes, Obesity and Metabolism on Dec. 2 validated an existing score (The Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes [TRS-HFDM]) for stratifying patients with type 2 diabetes by their risk of heart failure outcomes. The TRS-HFDM includes prior heart failure, atrial fibrillation, coronary artery disease, estimated glomerular filtration rate, and urine albumin-to-creatinine ratio. In 5,123 participants from the ACCORD trial, the study found that increasing scores corresponded to increasing heart failure risk, from 1.3 per 1,000 person-years with a score of zero to 64.7 per 1,000 person-years with a score of four or above. The authors of the study similarly suggested that their score could be used to target therapies like SGLT-2 inhibitors in diabetes patients with the highest risk for heart failure. They called for the score to be validated in real-world populations.

In addition, a research letter published by JAMA Cardiology on Nov. 25 quantified the rate of heart failure hospitalizations among U.S. patients with diabetes, comparing it with that for ischemic heart disease. It found that between 1995 and 2015, heart disease hospitalizations in this population fell by 67.8%, compared to a 38.9% decline in heart failure hospitalizations. The decreases in heart failure were steady until 2013, when they plateaued. The proportion of heart failure hospitalizations occurring among patients ages 65 years and older declined during the study period. The authors also cited SGLT-2 inhibitors as a potential therapy for at-risk patients. “Given high morbidity and mortality among patients with concomitant diabetes and HF, after decades focused predominantly on atherosclerotic cardiovascular disease prevention, preventive strategies must be broadened to target HF risk in this population,” they wrote.