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Cited by 63Heart Failure Treatment and ManagementCardiovascular Function and Risk FactorsDiabetes, Cardiovascular Risks, and Lipoproteins

Diabetes Mellitus and Risk of New-Onset and Recurrent Heart Failure: A Systematic Review and Meta-Analysis

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Kodama*, Satoru, Fujihara, Kazuya, Horikawa, Chika, Sato, Takaaki, Iwanaga, Midori, Yamada, Takaho, Kato, Kiminori, Watanabe, Kenichi +3 more·2020·ESC Heart Failure
DOI 10.1002/ehf2.12782PMC PMC7524078
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Abstract

Despite mounting evidence of the positive relationship between diabetes mellitus (DM) and heart failure (HF), the entire context of the magnitude of risk for HF in relation to DM remains insufficiently understood. The principal reason is because new-onset HF (HF occurring in participants without a history of HF) and recurrent HF (HF re-occurring in patients with a history of HF) are not discriminated. This meta-analysis aims to comprehensively and separately assess the risk of new-onset and recurrent HF depending on the presence or absence of DM. We systematically searched cohort studies that examined the relationship between DM and new-onset or recurrent HF using EMBASE and MEDLINE (from 1 Jan 1950 to 28 Jul 2019). The risk ratio (RR) for HF in individuals with DM compared with those without DM was pooled with a random-effects model. Seventy-four and 38 eligible studies presented data on RRs for new-onset and recurrent HF, respectively. For new-onset HF, the pooled RR [95% confidence interval (CI)] of 69 studies that examined HF as a whole [i.e. combining HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF)] was 2.14 (1.96–2.34). The large between-study heterogeneity (I2 = 99.7%, P < 0.001) was significantly explained by mean age [pooled RR (95% CI) 2.60 (2.38–2.84) for mean age < 60 years vs. pooled RR (95% CI) 1.95 (1.79–2.13) for mean age ≥ 60 years] (P < 0.001). Pooled RRs (95% CI) of seven and eight studies, respectively, that separately examined HFpEF and HFrEF risk were 2.22 (2.02–2.43) for HFpEF and 2.73 (2.71–2.75) for HFrEF. The risk magnitudes between HFpEF and HFrEF were not significantly different in studies that examined both HFpEF and HFrEF risks (P = 0.86). For recurrent HF, pooled RR (95% CI) of the 38 studies was 1.39 (1.33–1.45). The large between-study heterogeneity (I2 = 80.1%, P < 0.001) was significantly explained by the proportion of men [pooled RR (95% CI) 1.53 (1.40–1.68) for < 65% men vs. 1.32 (1.25–1.39) for ≥65% men (P = 0.01)] or the large pooled RR for studies of only participants with HFpEF [pooled RR (95% CI), 1.73 (1.32–2.26) (P = 0.002)]. Results indicate that DM is a significant risk factor for both new-onset and recurrent HF. It is suggested that the risk magnitude is large for new-onset HF especially in young populations and for recurrent HF especially in women or individuals with HFpEF. DM is associated with future HFpEF and HFrEF to the same extent.

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  • Diabetes is an important risk factor for incident heart failure, which is at least twofold more prevalent in people with diabetes compared with those without diabetes and is a major cause of morbidity and mortality.

    “Diabetes is also an important risk factor for incident heart failure, which is at least twofold more prevalent in people with diabetes compared with those without diabetes and is a major cause of morbidity and mortality (11).”

    From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [11]

    The Results section (page unavailable) reports a pooled risk ratio of 2.14 for new-onset heart failure in people with diabetes versus those without, supporting the incident-risk claim. That measures risk, not how prevalent heart failure is in the two groups. The Introduction describes heart failure as a major clinical and public-health problem, but the passages do not establish the claim about mortality. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Heart failure is a major cause of morbidity and mortality in people with diabetes.

    “and is a major cause of morbidity and mortality (11).”

    From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [11]

    The Introduction describes heart failure as a major clinical and public-health problem that impairs daily living, and the Results report higher risks of new-onset and recurrent heart failure in people with diabetes. This supports the morbidity aspect. The Methods say the analysis included fatal and nonfatal heart-failure events but excluded studies with only heart-failure mortality as an endpoint; the cited findings do not establish that heart failure is a major cause of mortality in people with diabetes. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Heart failure is at least twofold more prevalent in people with diabetes compared with those without diabetes.

    “which is at least twofold more prevalent in people with diabetes compared with those without diabetes”

    From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [11]

    The Results section (Overall analysis of new-onset heart failure risk; page unavailable) reports a pooled risk ratio of 2.14 for new-onset heart failure in people with diabetes versus those without. That supports an approximately twofold higher risk, but the paper measures new-onset risk, not how prevalent heart failure is; its 95% confidence interval of 1.96–2.34 also does not establish 'at least twofold' throughout. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Diabetes is a risk factor for incident heart failure.

    “diabetes is a risk factor for incident heart failure, which is at least twofold more prevalent in people with diabetes compared with those without diabetes and is a major cause of morbidity and mortality (11).”

    From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [11]

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Authors
Kodama*, S., Fujihara, K., Horikawa, C., Sato, T., Iwanaga, M., Yamada, T., Kato, K., Watanabe, K., Shimano, H., Izumi, T., & Sone, H.
Affiliations
  • Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Niigata University Graduate School of Medical and Dental Sciences , Niigata ,
  • Niigata University (JP)
  • University of Niigata Prefecture (JP)
  • University of Tsukuba (JP)
  • Department of Cardiology, Niigata Minami Hospital , Niigata ,
ORCID
Venue
ESC Heart Failure
Publisher
Oxford University Press (OUP)
Published
2020-07-29
Volume
7
Issue
5
Pages
2146-2174
ISSN
2055-5822 (ISSN-L)
DOI
10.1002/ehf2.12782
PMC
PMC7524078
OpenAlex
W3045587061
Cited by
63
References
146
Citations by year
2026: 10 · 2025: 13 · 2024: 13 · 2023: 9 · 2022: 8 · 2021: 8 · 2020: 2
FWCI
1.15
Type
journal article
Language
en
Open access
Licence
Locations
  • ESC Heart Failure (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Institutional Repositories DataBase (IRDB) (submittedVersion)
  • Terrestrial Environment Research Center (University of Tsukuba) (submittedVersion)
Funders
Japan Society for the Promotion of Science (19K12840)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
diabetes mellitus, heart failure, new-onset heart failure, heart failure recurrence, heart failure with preserved ejection fraction, heart failure with reduced ejection fraction, relative risk, age as confounder, cardiovascular risk stratification
MeSH terms
Diabetes Mellitus, Female, Heart Failure, Humans, Male, Middle Aged, Prognosis, Risk Factors, Stroke Volume

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