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Microvascular complications in diabetes patients with heart failure and reduced ejection fraction

Session Comorbidities and cardiomyopathies - How to manage?

Speaker Soeren Lund Kristensen

Event : Heart Failure 2018

  • Topic : heart failure
  • Sub-topic : Heart Failure with Reduced Ejection Fraction
  • Session type : Rapid Fire Abstracts

Authors : S L Kristensen (Copenhagen,DK), R Roerth (Glasgow,GB), PS Jhund (Glasgow,GB), L Shen (Glasgow,GB), M Lee (Glasgow,GB), MC Petrie (Glasgow,GB), L Kober (Copenhagen,DK), J Mcmurray (Glasgow,GB)

S L Kristensen1 , R Roerth2 , PS Jhund2 , L Shen2 , M Lee2 , MC Petrie2 , L Kober1 , J Mcmurray2 , 1Rigshospitalet - Copenhagen University Hospital, Cardiology - Copenhagen - Denmark , 2Cardiovascular Research Centre of Glasgow, Cardiology - Glasgow - United Kingdom ,

On behalf: BEST investigators


Background: The role of microvascular complications in the risk conferred by diabetes in heart failure with reduced ejection fraction (HFrEF) is unknown.

Methods: We studied 2707 HFrEF patients in the Beta-blocker Evaluation of Survival Trial (BEST), stratified into 3 groups: no diabetes and diabetes without or with microvascular complications (neuropathy, nephropathy or retinopathy). The risks of the composite of cardiovascular death or heart failure hospitalization, and all-cause death, were studied using Cox regression analyses adjusted for other prognostic variables.

Results: 964 patients had diabetes, of which 313 (32%) had microvascular complications. Patients with microvascular complications had more severe symptoms (New York Heart Association functional class IV 12% vs. 9% diabetes with no complications and 7% no diabetes), and worse quality of life (Minnesota living with HF median score 60 vs. 54 and 51 points). In patients with diabetes and complications, the rate of the composite outcome was 45 per 100 person-years of follow-up (compared with 34 and 29 in those with diabetes and no microvascular complications and participants without diabetes, respectively). Compared to patients without diabetes, the adjusted hazard ratio (HR) for the composite outcome was 1.44 (95% CI 1.22-1.70) and 1.18 (1.03-1.35) for patients with diabetes with and without complications, respectively. The risk of all-cause mortality was similarly elevated: adjusted HR 1.42 (95% CI 1.16-1.74) and 1.20 (1.01-1.42), respectively (Figure 1). Each type of microvascular complication was associated with a similar increment in risk and patients with more than one complication had an even greater elevation in risk.

Interpretation: In HFrEF, diabetes with microvascular complications is associated with worse symptoms and outcomes, than diabetes without microvascular complications. Prevention of microvascular complications has the potential to improve HFrEF outcomes.

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