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. 2021 Aug;9(8):594-603.
doi: 10.1016/j.jchf.2021.06.005.

Duration of Diabetes and Incident Heart Failure: The ARIC (Atherosclerosis Risk In Communities) Study

Justin B Echouffo-Tcheugui  1 , Sui Zhang  2 , Roberta Florido  3 , Carine Hamo  3 , James S Pankow  4 , Erin D Michos  3 , Ronald B Goldberg  5 , Vijay Nambi  6 , Gary Gerstenblith  3 , Wendy S Post  3 , Roger S Blumenthal  3 , Christie M Ballantyne  6 , Josef Coresh  2 , Elizabeth Selvin  2 , Chiadi E Ndumele  3
Affiliations

Duration of Diabetes and Incident Heart Failure: The ARIC (Atherosclerosis Risk In Communities) Study

Justin B Echouffo-Tcheugui et al. JACC Heart Fail. 2021 Aug.

Abstract

Objectives: This study assessed the association of diabetes duration with incident heart failure (HF).

Background: Diabetes increases HF risk. However, the independent effect of diabetes duration on incident HF is unknown.

Methods: We included 9,734 participants (mean age 63 years, 58% women, 22% Black) at ARIC (Atherosclerosis Risk In Communities) Visit 4 (1996-1998) without HF or coronary heart disease. We calculated diabetes duration at Visit 4 (baseline), utilizing diabetes status at the first 4 ARIC visits spaced 3 years apart, and self-reported diagnosis date for those with diabetes diagnosed before Visit 1. We used Cox regression to estimate associations of diabetes duration with incident HF, accounting for intercurrent coronary heart disease and other risk factors. We performed analyses stratified by age (<65 years or ≥65 years), race, sex, and glycemic control (hemoglobin A1C [HbA1C] consistently <7%, vs HbA1C ≥7%), with tests for interaction.

Results: Over 22.5 years of follow-up, there were 1,968 HF events. Compared to those without diabetes, HF risk rose with longer diabetes duration, with the highest risk among those with ≥15 y diabetes duration (HR: 2.82; 95% CI: 2.25-3.63). Each 5-year increase in diabetes duration was associated with a 17% (95% CI: 11-22) relative increase in HF risk. Similar results were observed across HF subtypes. The HF and diabetes duration associations were stronger among those aged <65 years, those with HbA1C ≥7%, those with a body mass index ≥30 kg/m2, women, and Blacks (all P interactions <0.05).

Conclusions: Delaying diabetes onset may augment HF prevention efforts, and therapies to improve HF outcomes might target those with long diabetes duration.

Keywords: duration of disease; heart failure; outcomes; risk; type 2 diabetes.

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Conflict of interest statement

Funding Support and Author Disclosures The ARIC study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), and Department of Health and Human Services, under Contract nos. HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I. The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr Tcheugui was supported by National Institutes of Health (NIH)/NHLBI grant K23 HL153774. Dr Hamo was supported by NIH/NHLBI grant number T32 HL007024. Dr Selvin was supported by NIH/National Institute of Diabetes and Digestive and Kidney Diseases grants K24 HL152440 and R01DK089174, and American Heart Association grant 20SFRN35120152. Dr Ndumele was supported by NIH grant R01HL146907 and American Heart Association grant 20SFRN35120152. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Central Illustration:
Central Illustration:. Restricted cubic splines of the diabetes duration association with heart failure among individuals with diabetes
P value for non-linearity are only relevant to those with diabetes
See this image and copyright information in PMC

References

    1. Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012. JAMA 2015;314:1021–1029. - PubMed
    1. Virani SS, Alonso A, Aparicio HJ, et al. Heart Disease and Stroke Statistics—2021 Update: A Report From the American Heart Association. Circulation 2021;143:e254–e743. - PubMed
    1. Aune D, Schlesinger S, Neuenschwander M, et al. Diabetes mellitus, blood glucose and the risk of heart failure: A systematic review and meta-analysis of prospective studies. Nutr. Metab. Cardiovasc. Dis 2018;28:1081–1091. - PubMed
    1. Ohkuma T, Komorita Y, Peters SAE, Woodward M. Diabetes as a risk factor for heart failure in women and men: a systematic review and meta-analysis of 47 cohorts including 12 million individuals. Diabetologia 2019;62:1550–1560. - PMC - PubMed
    1. Burchfiel CM, Reed DM, Marcus EB, Strong JP, Hayashi T. Association of Diabetes Mellitus with Coronary Atherosclerosis and Myocardial Lesions. Am. J. Epidemiol 1993;137:1328–40. - PubMed

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