UK: Recent data from the PARAGON-HF trial showed that pre-diabetes is common in heart failure with preserved ejection fraction (HFpEF) patients and is tied to a greater risk of heart failure hospitalizations (HFH) and worse clinical outcomes. The study was published in the European Journal of Heart Failure on 17 December 2021.
Previous studies have shown an association between HFpEF and insulin resistance but not much is known about the diabetic continuum, and in particular about pre-diabetes, in HFpEF. John J.V. McMurray, BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK, and colleagues, therefore, aimed to examine the characteristics and outcomes of participants with diabetes or pre-diabetes in PARAGON-HF.
The study included patients aged ≥50 years with left ventricular ejection fraction ≥45%, structural heart disease, and elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP). They were divided on the basis of glycated haemoglobin (HbA1c): (i) normal HbA1c, <6.0%; (ii) pre-diabetes, 6.0%–6.4%; (iii) diabetes, ≥6.5% or history of diabetes.
The primary outcome was a composite of cardiovascular (CV) death and total HFH.
Following were the study's salient findings:
Of 4796 patients, 50% had diabetes and 18% had pre-diabetes.
Compared to patients with normal HbA1c, patients with pre-diabetes and diabetes more often were obese, had a history of myocardial infarction and had lower Kansas City Cardiomyopathy Questionnaire scores, while patients with diabetes had more clinical evidence of congestion, but similar NT-proBNP concentrations.
The risks of the primary composite outcome (rate ratio [RR] 1.59), total HFH (RR 1.67), and CV death (hazard ratio [HR] 1.35) were higher among patients with diabetes, compared to those with normal HbA1c.
Patients with pre-diabetes had a higher risk (which was intermediate between that of patients with diabetes and those with normal HbA1c) of the primary outcome (HR 1.27) and HFH (HR 1.35), but not of CV death (HR 1.02).
Patients with diabetes treated with insulin had worse outcomes than those not, and those with 'lean diabetes' had similar mortality rates to those with a higher body mass index, but lower rates of HFH.
"Pre-diabetes is common in patients with HFpEF and is associated with worse clinical status and greater risk of HFH," the authors concluded.
Reference:
Jackson, A.M., Rørth, R., Liu, J., Kristensen, S.L., Anand, I.S., Claggett, B.L., Cleland, J.G., Chopra, V.K., Desai, A.S., Ge, J., Gong, J., Lam, C.S., Lefkowitz, M.P., Maggioni, A.P., Martinez, F., Packer, M., Pfeffer, M.A., Pieske, B., Redfield, M.M., Rizkala, A.R., Rouleau, J.L., Seferović, P.M., Tromp, J., Van Veldhuisen, D.J., Yilmaz, M.B., Zannad, F., Zile, M.R., Køber, L., Petrie, M.C., Jhund, P.S., Solomon, S.D., McMurray, J.J. and (2022), Diabetes and pre-diabetes in patients with heart failure and preserved ejection fraction. Eur J Heart Fail. https://doi.org/10.1002/ejhf.2403