Congestive Heart Failure in Type 2 Diabetes
Open accessAbstract
OBJECTIVE—To estimate the prevalence and incidence of congestive heart failure (CHF) in populations with and without type 2 diabetes and to identify risk factors for diabetes-associated CHF. RESEARCH DESIGN AND METHODS—We searched the inpatient and outpatient electronic medical records of 9,591 individuals diagnosed with type 2 diabetes before 1 January 1997 and those of an age- and sex-matched control group without diabetes for a diagnosis of CHF. Among those without a baseline diagnosis of CHF, we searched forward for 30 months for incident cases of CHF. We constructed multiple logistic regression models to identify risk factors for both prevalent and incident CHF. RESULTS—CHF was prevalent in 11.8% (n = 1,131) of diabetic subjects and 4.5% (n = 435) of control subjects at baseline. We observed incident cases of CHF in 7.7% of diabetic subjects free of CHF at baseline (650 of 8,460) and in 3.4% of control subjects (314 of 9,156). In diabetic subjects, age, diabetes duration, insulin use, ischemic heart disease, and elevated serum creatinine were independent risk factors for both prevalent and incident CHF. Better glycemic control at baseline, and improved glycemic and blood pressure control at follow-up predicted the development of CHF. CONCLUSIONS—Despite controlling for age, duration of diabetes, presence of ischemic heart disease, and presence of hypertension, insulin use was associated with both prevalent and incident CHF. Why insulin use and better glycemic control both at baseline and follow-up independently predicted CHF deserves further study.
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Ischaemic heart disease is often accelerated, severe, diffuse, and silent, and increases the risk of myocardial infarction and ischaemic myocardial dysfunction.
“IHD is often accelerated, severe, diffuse, and silent, and increases the risk of MI and ischaemic myocardial dysfunction.[449][450][451][452]”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [451]
Lower-extremity artery disease, longer diabetes duration, ageing, increased BMI, and chronic kidney disease are associated with heart failure in patients with diabetes.
“Observational data have also identified that lower-extremity artery disease (LEAD), longer diabetes duration, ageing, increased BMI, and CKD (Section 9) are associated with HF in patients with diabetes (Table 10). [449]][450][451][452]”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [451]
T2DM increases the incidence of HF up to more than double with respect to non-affected individuals, and this complication may develop independently of coronary artery disease and associated risk factors.
“Since the report of the Framingham Heart study, type 2 diabetes (T2DM) has been known to increase the incidence of HF up to more than double with respect to non-affected individuals, with the growing awareness that this complication may develop independently of coronary artery disease (CAD) and associated risk factors [8,9,10,11].”
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 [9]
In a Kaiser Permanente study, the incidence of T2DM was significantly higher in patients with than without HF (13.6/1000 vs. 9.2/1000) over a 5-year follow-up.
“In a Kaiser Permanente study, the incidence of T2DM was significantly higher in patients with than without HF (i.e.13.6/1000 vs. 9.2/1000) over a 5-year follow-up.10”
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 [10]
In patients with HF, data from observational and clinical trials demonstrate an increased risk for new-onset T2DM compared to patients without HF.
“In patients with HF, data from observational and clinical trials demonstrate an increased risk for new-onset T2DM compared to patients without HF.”
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 [10]
T2DM is an independent risk factor for the development of HF.
“T2DM is an independent risk factor for the development of HF. 10”
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 [10]
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- Authors
- Nichols, G. A., Hillier, T. A., Erbey, J. R., & Brown, J. B.
- Affiliations
- Kaiser Permanente Center for Health Research (US)
- Schering-Plough Pharmaceuticals, Kenilworth, New Jersey
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2001-09-01
- Volume
- 24
- Issue
- 9
- Pages
- 1614-1619
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2165832533
- Cited by
- 600
- References
- 45
- Citations by year
- 2026: 14 · 2025: 21 · 2024: 24 · 2023: 20 · 2022: 29 · 2021: 36 · 2020: 33 · 2019: 36 · 2018: 47 · 2017: 23 · 2016: 29 · 2015: 22 · 2014: 26 · 2013: 18 · 2012: 20
- FWCI
- 11.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- 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 Treatment and Management
- Keywords
- congestive heart failure, type 2 diabetes, prevalence, incidence, risk factors, insulin use, glycemic control, blood pressure control, diabetes duration, ischemic heart disease, serum creatinine, hypertension
- MeSH terms
- Aged, Aged, 80 and over, Blood Pressure, Body Weight, Diabetes Mellitus, Type 2, Female, Heart Failure, Glycated Hemoglobin, Hospital Records, Humans, Male, Middle Aged, Oregon, Regression Analysis, Risk Factors, Incidence, Prevalence, Databases, Factual, Myocardial Ischemia, Age Distribution
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