The Prognostic Significance of Diabetes and Microvascular Complications in Patients with Heart Failure with Preserved Ejection Fraction
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OBJECTIVE This study examined the prognostic significance of diabetes and microvascular complications in patients with heart failure with preserved ejection fraction (HFpEF). RESEARCH DESIGN AND METHODS This analysis included 3,385 patients (mean age 69 ± 9.6 years; 49% male; 89% white) with HFpEF from the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial (TOPCAT). Diabetes and microvascular complications were ascertained by self-reported history and medical record review. Microvascular complications included neuropathy, nephropathy, and retinopathy. Outcomes included hospitalization, hospitalization for heart failure, death, and cardiovascular death. Cox regression was used to examine the risk of each outcome associated with diabetes and microvascular complications. RESULTS Of the 1,109 subjects (32%) with diabetes, 352 (32%) had at least one microvascular complication. Patients with diabetes and microvascular complications had an increased risk for hospitalization (no diabetes: referent; diabetes + no microvascular complication: hazard ratio [HR] 1.18, 95% CI 1.01, 1.37; diabetes + microvascular complications: HR 1.54, 95% CI 1.25, 1.89; P-trend <0.001), hospitalization for heart failure (no diabetes: referent; diabetes + no microvascular complication: HR 1.51, 95% CI 1.14, 1.99; diabetes + microvascular complications: HR 1.97, 95% CI 1.38, 2.80; P-trend <0.001), death (no diabetes: referent; diabetes + no microvascular complication: HR 1.35, 95% CI 1.04, 1.75; diabetes + microvascular complications: HR 1.73, 95% CI 1.22, 2.45; P-trend = 0.0017), and cardiovascular death (no diabetes: referent; diabetes + no microvascular complication: HR 1.34, 95% CI 0.96, 1.86; diabetes + microvascular complications: HR 1.70, 95% CI 1.09, 2.65; P-trend = 0.018). When the analysis was limited to participants who reported prior hospitalization for heart failure (n = 2,449), a higher risk of rehospitalization for heart failure was observed across diabetes categories (no diabetes: referent; diabetes + no microvascular complication: HR 1.40, 95% CI 1.01, 1.96; diabetes + microvascular complications: HR 1.78, 95% CI 1.18, 2.70; P-trend = 0.0036). CONCLUSIONS Diabetes is associated with adverse cardiovascular outcomes in HFpEF, and the inherent risk of adverse outcomes in HFpEF patients with diabetes varies by the presence of microvascular complications.
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Diabetes markedly increases the development, morbidity and mortality of HFpEF.
“Diabetes markedly increases the development, morbidity and mortality of HF with preserved ejection fraction (HFpEF), showing a particularly close link with this clinical entity [14,15].”
From Dysregulated epicardial adipose tissue as a risk factor and potential therapeutic target of heart failure with preserved ejection fraction in diabetes (2022) · cites this paper as [15]
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- Authors
- Sandesara, P. B., O’Neal, W. T., Kelli, H. M., Samman-Tahhan, A., Hammadah, M., Quyyumi, A. A., & Sperling, L. S.
- Affiliations
- Emory University (US)
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Corresponding author
- Sandesara, Pratik B.
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2017-10-19
- Volume
- 41
- Issue
- 1
- Pages
- 150-155
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC5741155
- OpenAlex
- W2765144120
- Cited by
- 130
- References
- 18
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 10 · 2023: 9 · 2022: 29 · 2021: 23 · 2020: 26 · 2019: 16 · 2018: 9 · 2017: 1
- FWCI
- 10.97
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Diabetes Care (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Abraham J. & Phyllis Katz Foundation
- National Heart, Lung, and Blood Institute of the National Institutes of Health (F32-HL-134290)
- 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 › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- heart failure with preserved ejection fraction, diabetes mellitus, microvascular complications, diabetic neuropathy, diabetic nephropathy, diabetic retinopathy, prognosis, hospitalization, cardiovascular mortality, TOPCAT, mineralocorticoid receptor antagonists, cardiovascular mortality risk
- MeSH terms
- Aged, Mineralocorticoid Receptor Antagonists, Creatinine, Diabetes Mellitus, Double-Blind Method, Female, Follow-Up Studies, Heart Failure, Hospitalization, Humans, Insulin, Male, Middle Aged, Prognosis, Risk Factors, Stroke Volume, Endpoint Determination, Diabetes Complications
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