Relationship between overweight and obesity with hospitalization for heart failure in 20,985 patients with type 1 diabetes: a population-based study from the Swedish National Diabetes Registry

Abstract

Objective: To investigate the potential relationship between overweight, obesity, and severe obesity and the risk of hospitalization for heart failure (HF) in patients with type 1 diabetes.

Research design and methods: We studied patients with type 1 diabetes included in the Swedish National Diabetes Registry during 1998-2003, and they were followed up until hospitalization for HF, death, or 31 December 2009. Cox regression was used to estimate relative risks.

Results: In a sample of 20,985 type 1 diabetic patients (mean age, 38.6 years; mean BMI, 25.0 kg/m(2)), 635 patients were hospitalized with HF as a primary or secondary diagnosis during a median follow-up of 9.1 years. Cox regression adjusting for age, sex, diabetes duration, smoking, HbA1c, systolic and diastolic blood pressures, and baseline and intercurrent comorbidities (including myocardial infarction) showed a significant relationship between BMI and hospitalization for HF (P < 0.0001). In reference to patients in the BMI 20-25 kg/m(2) category, hazard ratios (HRs) were as follows: HR 1.22 (95% CI, 0.83-1.78) for BMI <20 kg/m(2); HR 0.94 (95% CI, 0.78-1.12) for BMI 25-30 kg/m(2); HR 1.55 (95% CI, 1.20-1.99) for BMI 30-35 kg/m(2); and HR 2.90 (95% CI, 1.92-4.37) for BMI ≥ 35 kg/m(2).

Conclusions: Obesity, particularly severe obesity, is strongly associated with hospitalization for HF in patients with type 1 diabetes, whereas no similar relation was present in overweight and low body weight.

Figure 1

Incidence rates with 95% CIs for HF by updated mean BMI category in patients with type 1 diabetes diagnosed at 11–20 years of age or after 20 years of age and belonging to two different age groups. Incidence estimations were made using a Poisson regression model including age, age at onset, sex, and updated mean BMI as explanatory variables.