Disclosures: Honigberg reports he received grant support from the NIH. Please see the study for all other authors’ relevant financial disclosures.
December 18, 2020
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HF prevention strategies needed in patients with diabetes

Disclosures: Honigberg reports he received grant support from the NIH. Please see the study for all other authors’ relevant financial disclosures.
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Preventive HF strategies must be broadened to target patients with diabetes, according to study findings published in JAMA Cardiology.

Michael C. Honigberg

“Diabetes increases the risk of HF, independent of ischemic heart disease (IHD); over the last several decades, the medical community has focused primarily on preventing macrovascular complications of diabetes (heart attack and stroke), as well as microvascular complications (neuropathy, nephropathy, retinopathy),” Michael C. Honigberg, MD, MPP, cardiologist and researcher at Massachusetts General Hospital and instructor in medicine at Harvard Medical School, told Healio. “We wanted to understand how these traditional prevention efforts for patients with diabetes have influenced trends in HF in this high-risk population.”

Diabetes Words 2019
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To investigate the burden of HF compared with IHD, researchers extracted data on patients aged at least 18 years using the CDC National Health Interview Survey from 1995 to 2015. Researchers further analyzed data and estimated hospitalization rates using the U.S. National Inpatient Sample.

The age-adjusted incidence of IHD hospitalization was double that of HF hospitalization in 1995 (37.6 [95% CI, 33.8-41.4] per 1,000 adults with diabetes vs. 19 [95% CI, 17.2-10.8] per 1,000 adults with diabetes), according to the researchers.

However, IHD hospitalization rates fell from 1995 to 2015 by 67.8% (95% CI, 57.5-78.1) in adults with diabetes, whereas HF hospitalization rates fell 38.9% (95% CI, 29.1-48.8) in that population.

In a geometric analysis, the mean change in IHD hospitalization was –6.3% per year (P < .001), steeper than the mean change of –3.4% per year (P < .001) in HF hospitalization; both trends were nonlinear (P for difference in slopes < .001).

Further analysis showed a decline in total HF hospitalization among patients aged at least 65 years, whereas incidence of HF hospitalization remained stable in younger patients. After 2012, HF hospitalizations were higher in men with diabetes vs. women with diabetes (12.6 per 1,000 adults with diabetes vs. 9.9 per 1,000 adults with diabetes; 27% difference; P < .001).

“We found substantial overall improvements in IHD in the population with diabetes. In contrast with these improvements, I was surprised by the relative lack of national progress in HF hospitalizations,” Honigberg told Healio. “The SGLT2 inhibitors, originally developed as antidiabetic medications, have emerged as a powerful tool to mitigate HF risk. It’s also important not to forget the basics and the importance of primordial and primary prevention — heart-healthy diet, exercise and weight loss — although these efforts may not be successful or suffcient to mitigate risk once diabetes develops. As they say, an ounce of prevention is worth a pound of cure.”