Optimal screening for predicting and preventing the risk of heart failure among adults with diabetes without atherosclerotic cardiovascular disease: a pooled cohort analysis
Open accessAbstract
BACKGROUND: The optimal approach to identify individuals with diabetes who are at a high risk for developing heart failure (HF) to inform implementation of preventive therapies is unknown, especially in those without atherosclerotic cardiovascular disease (ASCVD). METHODS: Adults with diabetes and no HF at baseline from 7 community-based cohorts were included. Participants without ASCVD who were at high risk for developing HF were identified using 1-step screening strategies: risk score (WATCH-DM [Weight, Age, Hypertension, Creatinine, HDL-C, Diabetes Control, QRS Duration, MI, and CABG] ≥12), NT-proBNP (N-terminal pro-B-type natriuretic peptide ≥125 pg/mL), hs-cTn (high-sensitivity cardiac troponin T ≥14 ng/L; hs-cTnI ≥31 ng/L), and echocardiography-based diabetic cardiomyopathy (echo-DbCM; left atrial enlargement, left ventricular hypertrophy, or diastolic dysfunction). High-risk participants were also identified using 2-step screening strategies with a second test to identify residual risk among those deemed low risk by the first test: WATCH-DM/NT-proBNP, NT-proBNP/hs-cTn, NT-proBNP/echo-DbCM. Across screening strategies, the proportion of HF events identified, 5-year number needed to treat and number needed to screen to prevent 1 HF event with an SGLT2i (sodium-glucose cotransporter 2 inhibitor) among high-risk participants, and cost of screening were estimated. RESULTS: The initial study cohort included 6293 participants (48.2% women), of whom 77.7% without prevalent ASCVD were evaluated with different HF screening strategies. At 5-year follow-up, 6.2% of participants without ASCVD developed incident HF. The 5-year number needed to treat to prevent 1 HF event with an SGLT2i among participants without ASCVD was 43 (95% CI, 29–72). In the cohort without ASCVD, high-risk participants identified using 1-step screening strategies had a low 5-year number needed to treat (22 for NT-proBNP to 37 for echo-DbCM). However, a substantial proportion of HF events occurred among participants identified as low risk using 1-step screening approaches (29% for echo-DbCM to 47% for hs-cTn). Two-step screening strategies captured most HF events (75–89%) in the high-risk subgroup with a comparable 5-year number needed to treat as the 1-step screening approaches (30–32). The 5-year number needed to screen to prevent 1 HF event was similar across 2-step screening strategies (45–61). However, the number of tests and associated costs were lowest for WATCH-DM/NT-proBNP ($1061) compared with other 2-step screening strategies (NT-proBNP/hs-cTn: $2894; NT-proBNP/echo-DbCM: $16 358). CONCLUSIONS: Selective NT-proBNP testing based on the WATCH-DM score efficiently identified a high-risk primary prevention population with diabetes expected to derive marked absolute benefits from SGLT2i to prevent HF.
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A meta-analysis combining RCTs and nonrandomized trial data showed improved cardiovascular outcomes with a combination of SGLT2i and GLP-1-based therapy along with a higher incidence of hypoglycemia.
“A meta-analysis combining RCTs and nonrandomized trial data showed improved cardiovascular outcomes with a combination of SGLT2i and GLP-1–based therapy along with a higher incidence of hypoglycemia,64”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [64]
The Methods (Statistical analysis; page unavailable) describe pooling seven cohorts to assess heart-failure screening and estimating SGLT2i benefit using a previously published meta-analysis. Searches for GLP-1–based combination therapy, nonrandomized trials, and hypoglycemia found no passage addressing the claimed combination-treatment outcomes. (LLM, conf=0.76)
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Self-citation
- Authors
- Patel, K. V., Segar, M. W., Klonoff, D. C., Khan, M. S., Usman, M. S., Lam, C. S. P., Verma, S., DeFilippis, A. P., Nasir, K., Bakker, S. J. L., Westenbrink, B. D., Dullaart, R. P. F., Butler, J., Vaduganathan, M., & Pandey, A.
- Affiliations
- Houston Methodist (US)
- Department of Cardiology, Texas Heart Institute, Houston (M.W.S.).
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA (D.C.K.).
- Duke University (US)
- The University of Texas Southwestern Medical Center (US)
- National University of Singapore (SG)
- St. Michael's Hospital (CA)
- Vanderbilt University Medical Center (US)
- University Medical Center Groningen (NL)
- University of Mississippi Medical Center (US)
- Brigham and Women's Hospital (US)
- ORCID
- Venue
- Circulation
- Published
- 2024-01-23
- Volume
- 149
- Issue
- 4
- Pages
- 293-304
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC11257100
- OpenAlex
- W4388586266
- Cited by
- 38
- References
- 49
- Citations by year
- 2026: 12 · 2025: 14 · 2024: 11 · 2023: 1
- FWCI
- 7.48
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- NIH NHLBI (R21HL169708)
- 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
- heart failure, diabetes mellitus, heart failure prediction, screening method, NT-proBNP, high-sensitivity troponin, diabetic cardiomyopathy, SGLT2 inhibitors, number needed to treat, number needed to screen, screening costs, atherosclerotic cardiovascular disease, left ventricular hypertrophy, diastolic dysfunction, left atrial enlargement
- MeSH terms
- Adult, Cardiovascular Diseases, Diabetes Mellitus, Female, Heart Failure, Humans, Male, Peptide Fragments, Cohort Studies, Biomarkers, Natriuretic Peptide, Brain, Troponin T, Atherosclerosis
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