Impact of Diabetes Mellitus on Hospitalization for Heart Failure, Cardiovascular Events, and Death: Outcomes at 4 Years From the Reduction of Atherothrombosis for Continued Health (REACH) Registry
Abstract
Background—: Despite the known association of diabetes mellitus with cardiovascular events, there are few contemporary data on the long-term outcomes from international cohorts of patients with diabetes mellitus. We sought to describe cardiovascular outcomes at 4 years and to identify predictors of these events in patients with diabetes mellitus. Methods and Results—: The Reduction of Atherothrombosis for Continued Health (REACH) registry is an international registry of patients at high risk of atherothrombosis or established atherothrombosis. Four-year event rates in patients with diabetes mellitus were determined with the corrected group prognosis method. Of the 45 227 patients in the REACH registry who had follow-up at 4 years, 43.6% (n=19 699) had diabetes mellitus at baseline. The overall risk and hazard ratio (HR) of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke were greater in patients with diabetes compared with patients without diabetes (16.5% versus 13.1%; adjusted HR, 1.27; 95% confidence interval [CI] 1.19–1.35). There was also an increase in both cardiovascular death (8.9% versus 6.0%; adjusted HR, 1.38; 95% CI, 1.26–1.52) and overall death (14.3% versus 9.9%; adjusted HR, 1.40; 95% CI, 1.30–1.51). Diabetes mellitus was associated with a 33% greater risk of hospitalization for heart failure (9.4% versus 5.9%; adjusted odds ratio, 1.33; 95% CI, 1.18–1.50). In patients with diabetes mellitus, heart failure at baseline was independently associated with cardiovascular death (adjusted HR, 2.45; 95% CI, 2.17–2.77; P <0.001) and hospitalization for heart failure (adjusted odds ratio, 4.72; 95% CI, 4.22–5.29; P <0.001). Conclusions—: Diabetes mellitus substantially increases the risk of death, ischemic events, and heart failure. Patients with both diabetes mellitus and heart failure are at particularly elevated risk of cardiovascular death, highlighting the need for additional therapies in this high-risk population.
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The observed annualized primary endpoint event rate for placebo patients in REDUCE-IT is consistent with historical cardiovascular outcome studies with comparable patient populations and expanded or hard MACE.
“The observed annualized primary endpoint event rate for placebo patients in REDUCE-IT was 5.74%, which is consistent with historical cardiovascular outcome studies, including those published since the design of REDUCE-IT, with comparable patient populations and expanded or hard major adverse cardiovascular events (MACE) (4,8,9,30-44).”
From Effects of Icosapent Ethyl on Total Ischemic Events (2019) · cites this paper as [4]
Patients with type 2 diabetes are at high risk for atherosclerotic cardiovascular disease and heart failure compared with nondiabetic individuals.
“Patients with T2DM are at high risk for ASCVD and HF compared with nondiabetic individuals (50,53).”
From SGLT2 inhibition for CKD and cardiovascular disease in type 2 diabetes: report of a scientific workshop sponsored by the National Kidney Foundation (2021) · cites this paper as [53]
Rates of incident heart failure hospitalization adjusted for age and sex were twofold higher in people with diabetes than in those without diabetes.
“Recent studies have found that rates of incident heart failure hospitalization (adjusted for age and sex) were twofold higher in people with diabetes compared with those without (5,6).”
From 10. Cardiovascular Disease and Risk Management: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [5]
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- Authors
- Cavender, M. A., Steg, P. G., Smith, S. C., Eagle, K., Ohman, E. M., Goto, S., Kuder, J., Im, K., Wilson, P. W. F., & Bhatt, D. L.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- From TIMI Study Group, Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (M.A.C., J.K., K.I., D.L.B.); French Alliance for Cardiovascular Clinical Trials, Département Hospitalo-Universitaire, Fibrosis, Inflammation, Remodeling, Université Paris-Diderot, Sorbonne Paris-Cité, Laboratory of Vascular Translational Science, INSERM U-1148, Hôpital Bichat, Hopitaux Universitaires Paris-Nord Val de Seine, Assistance Publique–Hôpitaux de Paris, Paris, France (P.G.S.);...
- ORCID
- Venue
- Circulation
- Published
- 2015-09-08
- Volume
- 132
- Issue
- 10
- Pages
- 923-931
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2154038775
- Cited by
- 501
- References
- 36
- Citations by year
- 2026: 11 · 2025: 19 · 2024: 43 · 2023: 51 · 2022: 75 · 2021: 61 · 2020: 80 · 2019: 56 · 2018: 49 · 2017: 34 · 2016: 17 · 2015: 4 · 2014: 1
- FWCI
- 30.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- diabetes mellitus, heart failure hospitalization, cardiovascular events, cardiovascular mortality, myocardial infarction, stroke, heart failure with reduced ejection fraction, risk factors, REACH registry, atherothrombosis, long-term outcomes, comorbidity burden, mortality risk stratification, heart failure with preserved ejection fraction
- MeSH terms
- Aged, Diabetes Mellitus, Female, Follow-Up Studies, Health Status, Heart Failure, Hospitalization, Humans, Male, Middle Aged, Mortality, Prospective Studies, Registries, Thrombosis, Time Factors, Cohort Studies, Treatment Outcome, Internationality, Atherosclerosis
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