Predictors of heart failure in diabetes mellitus

Predictors of heart failure in diabetes mellitus

Patients with diabetes mellitus are more prone to develop heart failure than others. Important features of diabetes mellitus associated with the development of heart failure are [1]:

1. Poor glycemic control
2. Longer duration of diabetes mellitus
3. Diabetes on insulin treatment
4. Presence of microvascular complications like retinopathy or nephropathy

Diabetes is known to increase the risk of heart failure two fold, which is much more in those with associated coronary artery disease. Presence of heart failure in diabetes mellitus is a significant risk factor for increased cardiovascular events. Reduction of Atherothrombosis for Continued Health (REACH) Registry showed a 33% increase in the risk of hospitalization for heart failure in patients with diabetes mellitus [2].

Some of the mechanisms which potentially increase the risk of heart failure in diabetes mellitus are chronic hyperglycemia, insulin resistance, autonomic dysfunction and enhanced renin-angiotensin-aldosterone system dysfunction. Presence of albuminuria is significantly associated with increased risk of heart failure. This may correlate with presence of microvascular complications mentioned earlier.  In this context, increase in albumin creatinine ratio increases the relative risk of hospitalization for heart failure. Insulin use has been associated with an increased risk of future heart failure events [3].

References

1. Verma S, McMurray JJV. The Serendipitous Story of SGLT2 Inhibitors in Heart Failure. New Insights From DECLARE-TIMI 58. Circulation. 2019;139:2542–2553.
2. Cavender MA, Steg PG, Smith SC Jr, Eagle K, Ohman EM, Goto S, Kuder J, Im K, Wilson PW, Bhatt DL; REACH Registry Investigators. Impact of Diabetes Mellitus on Hospitalization for Heart Failure, Cardiovascular Events, and Death: Outcomes at 4 Years From the Reduction of Atherothrombosis for Continued Health (REACH) Registry. Circulation. 2015 Sep 8;132(10):923-31.
3. Verma S, Sharma A, Kanumilli N, Butler J. Predictors of heart failure development in type 2 diabetes: a practical approach. Curr Opin Cardiol. 2019 Sep;34(5):578-583.