Effects of diabetes mellitus and ischemic heart disease on the progression from asymptomatic left ventricular dysfunction to symptomatic heart failure: a retrospective analysis from the Studies of Left Ventricular Dysfunction (SOLVD) Prevention trial
Abstract
Background Emerging data suggest that diabetes mellitus is a risk factor for the progression of established heart failure only in those patients with ischemic cardiomyopathy. Whether diabetes mellitus is a risk factor for the progression from asymptomatic left ventricular systolic dysfunction to symptomatic heart failure in patients with left ventricular dysfunction of an ischemic cause is not known.Methods We performed a retrospective analysis of 2821 patients with asymptomatic left ventricular systolic dysfunction from the Studies of Left Ventricular Dysfunction (SOLVD) Prevention trial. We used adjusted survival analysis to examine the effects of ischemic heart disease and diabetes mellitus on 3 prespecified study end points: (1) development of heart failure (HF) symptoms, (2) HF hospitalization, and (3) death or development of symptoms.Results There is a statistically significant interaction between the cause of left ventricular systolic dysfunction and diabetes mellitus on the risk of development of heart failure symptoms (P = .020). Patients with ischemic cardiomyopathy and diabetes had an increased risk of progression to symptomatic heart failure (HR = 1.56, P < .001), hospitalization for heart failure (HR = 2.16, P < .001), and death or development of symptoms (HR = 1.50, P < .001), compared with patients with ischemic cardiomyopathy without diabetes. In contrast, diabetes was not associated with an increased risk of reaching these end points in patients with nonischemic cardiomyopathy.Conclusions Diabetes mellitus is a risk factor for the progression from asymptomatic left ventricular systolic dysfunction to symptomatic heart failure, but this risk appears to be confined to those patients with ischemic cardiomyopathy.
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In the SOLVD-Prevention trial, patients with T2DM were more likely to progress to symptomatic HF than those without T2DM, although the increased risk appeared to be confined to patients with HF secondary to CAD.
“In the SOLVD-Prevention trial of patients with asymptomatic left ventricular systolic dysfunction, patients with T2DM were more likely to progress to symptomatic HF than those without T2DM, although the increased risk appeared to be confined to patients with HF secondary to CAD. 71”
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 [71]
In patients from a US study of HF clinics, a U-shaped relationship with regard to increased all-cause mortality was found; patients with low or very high HbA1c were at greatest risk.
“In patients from a US study of HF clinics, a U-shaped relationship with regard to increased all-cause mortality was found.71 or very high HbA 1c were at greatest risk.”
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 [71]
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- Authors
- Das, S. R., Drazner, M. H., Yancy, C. W., Stevenson, L. W., Gersh, B. J., & Dries, D. L.
- Affiliations
- The University of Texas Southwestern Medical Center (US)
- Brigham and Women's Hospital (US)
- Mayo Clinic (US)
- Corresponding author
- Das, Sandeep R.
- Venue
- American Heart Journal
- Publisher
- Elsevier BV
- Published
- 2004-11
- Volume
- 148
- Issue
- 5
- Pages
- 883-888
- ISSN
- 0002-8703 (ISSN-L)
- OpenAlex
- W2069594639
- Cited by
- 68
- References
- 30
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2022: 2 · 2021: 3 · 2020: 3 · 2019: 3 · 2018: 3 · 2017: 2 · 2016: 6 · 2015: 3 · 2014: 2 · 2013: 1 · 2012: 6
- FWCI
- 3.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- 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, ischemic heart disease, ischemic cardiomyopathy, left ventricular systolic dysfunction, heart failure progression, asymptomatic left ventricular dysfunction, heart failure hospitalization, mortality, non-ischemic cardiomyopathy, risk factors
- MeSH terms
- Analysis of Variance, Female, Heart Failure, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Survival Analysis, Myocardial Ischemia, Disease Progression, Ventricular Dysfunction, Left, Diabetes Complications
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