Diabetes and Progression of Heart Failure
Open accessAbstract
Background The influence of diabetes on progression from preclinical heart failure (HF) stages to overt HF is poorly understood. Objectives The purpose of this study was to characterize the influence of diabetes on the progression from preclinical HF stages (A or B based on the 2021 Universal Definition) to overt HF. Methods We included 4,774 adults with preclinical HF (stage A [n = 1,551] or B [n = 3,223]) who attended the ARIC (Atherosclerosis Risk In Communities) study Visit 5 (2011-2013). Within each stage (A or B), we assessed the associations of diabetes and glycemic control (hemoglobin A 1C [HbA 1C] <7% vs ≥7%) with progression to HF, and of cross-categories of HF stages (A vs B), diabetes, and glycemic control with incident HF. Results Among the participants (mean age 75.4 years, 58% women, 20% Black), there were 470 HF events during 8.6 years of follow-up. Stage B participants with HbA 1C ≥7% experienced clinical HF at a younger age than those with controlled diabetes or without diabetes (mean age 80 years vs 83 years vs 82 years; P < 0.001). HbA 1C ≥7% was more strongly associated with HF in stage B (HR: 1.83; 95% CI: 1.33-2.51) compared with stage A (HR: 1.52; 95% CI: 0.53-4.38). In cross-categories of preclinical HF stage and HbA 1C, participants with stage B and HbA 1C ≥7% had increased risk of HF progression compared with stage A without diabetes (HR: 7.56; 95% CI: 4.68-12.20). Conclusions Among older adults with preclinical HF stages, uncontrolled diabetes was associated with substantial risk of HF progression. Our results suggest that targeting diabetes early in the HF process is critical.
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People with diabetes are at particularly high risk for progression from asymptomatic stage A and B to symptomatic stage C and D heart failure.
“People with diabetes are at particularly high risk for progression from asymptomatic stage A and B to symptomatic stage C and D heart failure (219,220).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [220]
People with diabetes are at particularly high risk for progression from asymptomatic stage A and B to symptomatic stage C and D heart failure.
“People with diabetes are at particularly high risk for progression from asymptomatic stage A and B to symptomatic stage C and D heart failure (208,209).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [209]
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Natriuretic Peptide‐Based Screening to Identify Stage B Heart Failure in People With Type 1 Diabetes
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Editor-in-Chief’s Top Picks From 2022
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- Authors
- Echouffo-Tcheugui, J. B., Ndumele, C. E., Zhang, S., Florido, R., Matsushita, K., Coresh, J., Skali, H., Shah, A. M., & Selvin, E.
- Affiliations
- Johns Hopkins University (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Echouffo-Tcheugui, Justin B.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2022-06
- Volume
- 79
- Issue
- 23
- Pages
- 2285-2293
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC10125541
- OpenAlex
- W4281816045
- Cited by
- 54
- References
- 46
- Citations by year
- 2026: 11 · 2025: 13 · 2024: 18 · 2023: 9 · 2022: 3
- FWCI
- 7.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HHSN268201700004I, K24HL152440, HHSN268201700001I, R01HL146907, HHSN268201700005C, HHSN268201700003I, K23HL153774, K24HL152008, HHSN268201700005I, HHSN268201700001C, R01HL143224, HHSN268201700002I, R01HL150342, HHSN268201700003C, HHSN268201700002C, HHSN268201700004C, R01HL135008, R01HL148218)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK089174)
- 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 progression, preclinical heart failure, glycemic control, HbA1c, incident heart failure, older adults, Atherosclerosis Risk in Communities Study
- MeSH terms
- Aged, Aged, 80 and over, Diabetes Mellitus, Female, Heart Failure, Glycated Hemoglobin, Humans, Male, Risk Factors, Atherosclerosis
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