Prognostic impact of diabetes mellitus in patients with heart failure according to the etiology of left ventricular systolic dysfunction
Open accessAbstract
Objectives We sought to determine the relative impact of diabetes mellitus on prognosis in ischemic compared with nonischemic cardiomyopathy.Background Ischemic myocardium is characterized by increased reliance on aerobic and anaerobic glycolysis. Because glucose utilization by cardiomyocytes is an insulin-mediated process, we hypothesized that diabetes would have a more adverse impact on mortality and progression of heart failure in ischemic compared with nonischemic cardiomyopathy.Methods We performed a retrospective analysis of the Studies Of Left Ventricular Dysfunction (SOLVD) Prevention and Treatment trials.Results In adjusted analyses, diabetes mellitus was strongly associated with an increased risk for all-cause mortality in patients with ischemic cardiomyopathy, (relative risk [RR] 1.37, 95% confidence interval [CI] 1.21 to 1.55; p < 0.0001), but not in those with nonischemic cardiomyopathy (RR 0.98, 95% CI 0.76 to 1.32; p = 0.98). The increased mortality in patients with ischemic cardiomyopathy compared with nonischemic cardiomyopathy was limited to those with ischemic cardiomyopathy and diabetes mellitus (RR 1.37, 95% CI 1.21 to 1.56; p < 0.0001). When patients with ischemic cardiomyopathy and diabetes mellitus were excluded, there was no significant difference in mortality risk between the ischemic and nonischemic cardiomyopathy groups after adjusted analysis (RR 0.99, 95% CI 0.86 to 1.15; p = 0.99). Previous surgical revascularization identified patients within the cohort with ischemic cardiomyopathy and diabetes mellitus, with improved prognosis.Conclusions The differential impact of diabetes on mortality and heart failure progression according to the etiology of heart failure suggests that diabetes and ischemic heart disease interact to accelerate the progression of myocardial dysfunction. Evaluation of the potential for revascularization may be particularly important in patients with ischemic cardiomyopathy and diabetes mellitus.
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In three early clinical trials (SOLVD, BEST, and DIG), the risk appeared to be confined to those with an ischaemic aetiology.
“In three early clinical trials (SOLVD, 98 BEST, 94 and DIG 102 )t h er i s k appeared to be confined to those with an ischaemic aetiology.”
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 [98]
The majority of the available data suggests that T2DM is associated with higher risk of mortality in both patients of ischaemic and non-ischaemic aetiology.
“The majority of the available data suggests that T2DM is associated with higher risk of mortality in both patients of ischaemic and non-ischaemic aetiology (Table 6).29,88,94,96 -99”
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 [98]
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- Authors
- Dries, D. L., Sweitzer, N. K., Drazner, M. H., Stevenson, L. W., & Gersh, B. J.
- Affiliations
- The University of Texas Southwestern Medical Center (US)
- Brigham and Women's Hospital (US)
- Mayo Clinic (US)
- Corresponding author
- Dries, Daniel L
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2001-08
- Volume
- 38
- Issue
- 2
- Pages
- 421-428
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2110103927
- Cited by
- 286
- References
- 19
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 5 · 2023: 1 · 2022: 9 · 2021: 3 · 2020: 17 · 2019: 9 · 2018: 17 · 2017: 9 · 2016: 12 · 2015: 9 · 2014: 11 · 2013: 9 · 2012: 12
- FWCI
- 10.96
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- diabetes mellitus, heart failure, left ventricular systolic dysfunction, ischemic cardiomyopathy, non-ischemic cardiomyopathy, all-cause mortality, heart failure progression, revascularization, myocardial glucose utilization, insulin, SOLVD trial
- MeSH terms
- Coronary Artery Bypass, Female, Heart Failure, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Factors, Systole, Cohort Studies, Survival Rate, Myocardial Ischemia, Ventricular Dysfunction, Left, Diabetes Complications
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