Prevalence of Prediabetes and Undiagnosed Diabetes in Patients with HFpEF and HFrEF and Associated Clinical Outcomes
Open accessAbstract
PURPOSE: The prevalence and consequences of prediabetic dysglycemia and undiagnosed diabetes is unknown in patients with heart failure (HF) and preserved ejection fraction (HFpEF) and has not been compared to heart failure and reduced ejection fraction (HFrEF). METHODS: We examined the prevalence and outcomes associated with normoglycemia, prediabetic dysglycemia and diabetes (diagnosed and undiagnosed) among individuals with a baseline glycated hemoglobin (hemoglobin A1c, HbA1c) measurement stratified by HFrEF or HFpEF in the Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity programme (CHARM). We studied the primary outcome of HF hospitalization or cardiovascular (CV) death, and all-cause death, and estimated hazard ratios (HR) by use of multivariable Cox regression models. RESULTS: HbA1c was measured at baseline in CHARM patients enrolled in the USA and Canada and was available in 1072/3023 (35%) of patients with HFpEF and 1578/4576 (34%) patients with HFrEF. 18 and 16% had normoglycemia (HbA1c < 6.0), 20 and 22% had prediabetes (HbA1c 6.0-6.4), respectively. Finally among patients with HFpEF 22% had undiagnosed diabetes (HbA1c > 6.4), and 40% had known diabetes (any HbA1c), with corresponding prevalence among HFrEF patients being 26 and 35%. The rates of both clinical outcomes of interest were higher in patients with undiagnosed diabetes and prediabetes, compared to normoglycemic patients, irrespective of HF subtype, and in general higher among HFrEF patients. For the primary composite outcome among HFpEF patients, the HRs were 1.02 (95% CI 0.63-1.65) for prediabetes, HR 1.18 (0.75-1.86) for undiagnosed diabetes and 2.75 (1.83-4.11) for known diabetes, respectively, p value for trend across groups < 0.001. Dysglycemia was also associated with worse outcomes in HFrEF. CONCLUSIONS: These findings confirm the remarkably high prevalence of dysglycemia in heart failure irrespective of ejection fraction phenotype, and demonstrate that dysglycemia is associated with a higher risk of adverse clinical outcomes, even before the diagnosis of diabetes and institution of glucose lowering therapy in patients with HFpEF as well as HFrEF.
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T2DM is often unrecognized in HF patients, and vice versa.
“T2DM is often unrecognized in HF patients, and vice versa, which emphasizes the importance of an active search for both”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [108]
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- Authors
- CHARM Investigators and Committees, Kristensen, S. L., Jhund, P. S., Lee, M. M. Y., Køber, L., Solomon, S. D., Granger, C. B., Yusuf, S., Pfeffer, M. A., Swedberg, K., & McMurray, J. J. V.
- Affiliations
- Rigshospitalet (DK)
- British Heart Foundation (GB)
- Brigham and Women's Hospital (US)
- Duke Medical Center (US)
- Population Health Research Institute (CA)
- Imperial College London (GB)
- Corresponding author
- McMurray, John J. V.
- ORCID
- Venue
- Cardiovascular Drugs and Therapy
- Published
- 2017-09-25
- Volume
- 31
- Issue
- 5-6
- Pages
- 545-549
- ISSN
- 0920-3206 (ISSN-L)
- 1573-7241
- PMC
- PMC5730631
- OpenAlex
- W2758676322
- Cited by
- 83
- References
- 15
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 14 · 2023: 9 · 2022: 17 · 2021: 8 · 2020: 9 · 2019: 8 · 2018: 8
- FWCI
- 5.29
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Cardiovascular Drugs and Therapy (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
- Research Bank (Australian Catholic University) (submittedVersion, cc-by-nc)
- Funders
- AstraZeneca
- 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
- prediabetes, undiagnosed diabetes, heart failure with preserved ejection fraction, heart failure with reduced ejection fraction, HbA1c, dysglycemia, diabetes prevalence, heart failure hospitalization, cardiovascular mortality, all-cause mortality, CHARM trial, candesartan, renin-angiotensin system blockade
- MeSH terms
- Aged, Diabetes Mellitus, Female, Heart Failure, Glycated Hemoglobin, Humans, Male, Middle Aged, Prediabetic State, Stroke Volume, Comorbidity, Prevalence, Multivariate Analysis, Proportional Hazards Models
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