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Tao J, Sang D, Zhen L, Zhang X, Li Y, Wang G, Chen S, Wu S, Zhang W. Elevated urine albumin-to-creatinine ratio increases the risk of new-onset heart failure in patients with type 2 diabetes. Cardiovasc Diabetol 2023; 22:70. [PMID: 36966320 PMCID: PMC10040119 DOI: 10.1186/s12933-023-01796-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 03/10/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Although albuminuria has been linked to heart failure in the general population, the relationship between urine albumin-to-creatinine ratio (uACR) and heart failure in type 2 diabetes patients is not well understood. We aimed to investigate the relationship between uACR and new-onset heart failure (HF) in type 2 diabetics. METHODS We included 9287 Chinese participants with type 2 diabetes (T2D) but no heart failure (HF) who were assessed with uACR between 2014 and 2016. The participants were divided into three groups based on their baseline uACR: normal (< 3 mg/mmol), microalbuminuria (3-30 mg/mmol), and macroalbuminuria (≥ 30 mg/mmol). The relationship between uACR and new-onset HF was studied using Cox proportional hazard models and restricted cubic spline. The area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to see if incorporating uACR into existing models could improve performance. RESULTS 216 new-onset HF cases (2.33%) were recorded after a median follow-up of 4.05 years. When compared to normal uACR, elevated uACR was associated with a progressively increased risk of new-onset HF, ranging from microalbuminuria (adjusted HR, 2.21; 95% CI 1.59-3.06) to macroalbuminuria (adjusted HR, 6.02; 95% CI 4.11-8.80), and 1 standard deviation (SD) in ln (uACR) (adjusted HR, 1.89; 95% CI 1.68-2.13). The results were consistent across sex, estimated glomerular filtration rate, systolic blood pressure, and glycosylated hemoglobin subgroups. The addition of uACR to established HF risk models improved the HF risk prediction efficacy. CONCLUSIONS Increasing uACR, even below the normal range, is an independent risk factor for new-onset HF in a type 2 diabetic population. Furthermore, uACR may improve HF risk prediction in community-based T2D patients.
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Affiliation(s)
- Jie Tao
- Graduate School of Tianjin Medical University, No. 22, Qixiangtai Road, Heping District, Tianjin, China
| | - Dasen Sang
- Department of Cardiology, Baoding NO.1 Central Hospital, N0.320, Changcheng Street, Baoding, Hebei, China
| | - Libo Zhen
- Department of Cardiology, Baoding NO.1 Central Hospital, N0.320, Changcheng Street, Baoding, Hebei, China
| | - Xinxin Zhang
- Department of Cardiology, Baoding NO.1 Central Hospital, N0.320, Changcheng Street, Baoding, Hebei, China
| | - Yuejun Li
- Department of Cardiology, Baoding NO.1 Central Hospital, N0.320, Changcheng Street, Baoding, Hebei, China
| | - Guodong Wang
- Department of Cardiology, Kailuan General Hospital, 57 Xinhua Road (East), Tangshan, Hebei, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, 57 Xinhua Road (East), Tangshan, Hebei, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, 57 Xinhua Road (East), Tangshan, Hebei, China
| | - Wenjuan Zhang
- Department of Cardiology, Tianjin Medical University General Hospital, NO. 154, Anshan road, Heping District, Tianjin, China.
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Son TK, Toan NH, Thang N, Le Trong Tuong H, Tien HA, Thuy NH, Van Minh H, Valensi P. Prediabetes and insulin resistance in a population of patients with heart failure and reduced or preserved ejection fraction but without diabetes, overweight or hypertension. Cardiovasc Diabetol 2022; 21:75. [PMID: 35568879 PMCID: PMC9107647 DOI: 10.1186/s12933-022-01509-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/07/2022] [Indexed: 12/17/2022] Open
Abstract
Background The relationships between glucose abnormalities, insulin resistance (IR) and heart failure (HF) are unclear, especially regarding to the HF type, i.e., HF with reduced (HFrEF) or preserved (HFpEF) ejection fraction. Overweight, diabetes and hypertension are potential contributors to IR in persons with HF. This study aimed to evaluate the prevalence of prediabetes and IR in a population of Vietnamese patients with HFrEF or HFpEF but no overweight, diabetes or hypertension, in comparison with healthy controls, and the relation between prediabetes or IR and HF severity. Methods We conducted a prospective cross-sectional observational study in 190 non-overweight normotensive HF patients (114 with HFrEF and 76 with HFpEF, 92.6% were ischemic HF, mean age was 70.1 years, mean BMI 19.7 kg/m2) without diabetes (neither known diabetes nor newly diagnosed by OGTT) and 95 healthy individuals (controls). Prediabetes was defined using 2006 WHO criteria. Glucose and insulin levels were measured fasting and 2 h after glucose challenge. IR was assessed using HOMA-IR and several other indexes. Results Compared to controls, HF patients had a higher prevalence of prediabetes (63.2% vs 22.1%) and IR (according to HOMA-IR, 55.3% vs 26.3%), higher HOMA-IR, insulin/glucose ratio after glucose and FIRI, and lower ISIT0 and ISIT120 (< 0.0001 for all comparisons), with no difference for body weight, waist circumference, blood pressure and lipid parameters. Prediabetes was more prevalent (69.3% vs 53.9%, p = 0.03) and HOMA-IR was higher (p < 0.0001) in patients with HFrEF than with HFpEF. Among both HFrEF and HFpEF patients, those with prediabetes or IR had a more severe HF (higher NYHA functional class and NT-proBNP levels, lower ejection fraction; p = 0.04–< 0.0001) than their normoglycemic or non-insulinresistant counterparts, with no difference for blood pressure and lipid parameters. Conclusion In non-diabetic non-overweight normotensive patients with HF, the prevalence of prediabetes is higher with some trend to more severe IR in those with HFrEF than in those with HFpEF. Both prediabetes and IR are associated with a more severe HF. The present data support HF as a culprit for IR. Intervention strategies should be proposed to HF patients with prediabetes aiming to reduce the risk of incident diabetes. Studies should be designed to test whether such strategies may translate into an improvement of further HF-related outcomes.
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Affiliation(s)
- Tran Kim Son
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Ngo Hoang Toan
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Nguyen Thang
- Science - Technology & External Relations Office, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | | | - Hoang Anh Tien
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Nguyen Hai Thuy
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Huynh Van Minh
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Paul Valensi
- Unit of Endocrinology-Diabetology-Nutrition. Jean Verdier hospital, APHP, Sorbonne Paris Nord University, CINFO, CRNH-IdF, Bondy, France.
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Mai L, Wen W, Qiu M, Liu X, Sun L, Zheng H, Cai X, Huang Y. Association between prediabetes and adverse outcomes in heart failure. Diabetes Obes Metab 2021; 23:2476-2483. [PMID: 34227220 DOI: 10.1111/dom.14490] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/26/2021] [Accepted: 07/01/2021] [Indexed: 02/06/2023]
Abstract
AIMS Patients with heart failure (HF) and with diabetes experienced significantly worse outcomes than those without diabetes. However, data on the prognostic impact of prediabetes in HF are inconclusive. This meta-analysis aimed to explore the association between prediabetes and the risk of all-cause mortality and adverse cardiac outcomes in patients with HF. MATERIALS AND METHODS We searched multiple electronic databases (PubMed, Embase and Google Scholar) for relevant studies up to 31 March 2021. Studies were included for analysis if multivariable adjusted relative risks of adverse outcomes were reported in patients with prediabetes and with HF compared with those with normoglycaemia. Random-effects models were used to calculate the pooled hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Twelve studies comprising 28 643 patients with HF reported the risk of all-cause mortality and cardiac outcomes associated with prediabetes. The prevalence of prediabetes ranged from 9.6% to 37.2%. After a median follow-up duration of 2.3 years, patients with HF and with prediabetes were associated with an increased risk of all-cause mortality (HR 1.29, 95% CI 1.06-1.58), cardiovascular mortality (HR 1.59, 95% CI 1.09-2.32), HF hospitalization (HR 1.33, 95% CI 1.09-1.61), all-cause mortality and/or HF hospitalization (HR 1.22, 95% CI 1.01-1.47), as well as cardiovascular mortality and/or HF hospitalization (HR 1.21, 95% CI 1.07-1.37). CONCLUSIONS Prediabetes is associated with a worse prognosis in patients with HF. Further risk stratification and effective treatment strategies are needed in patients with prediabetes and with HF to improve the prognosis.
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Affiliation(s)
- Linlin Mai
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Weixing Wen
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Min Qiu
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Xiong Liu
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Lichang Sun
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Haoxiao Zheng
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Xiaoyan Cai
- Department of Scientific Research and Education, Shunde Hospital, Southern Medical University, Foshan, China
| | - Yuli Huang
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Guangzhou, China
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Ferrannini G, Savarese G, Rydén L. Sodium-glucose transporter inhibition in heart failure: from an unexpected side effect to a novel treatment possibility. Diabetes Res Clin Pract 2021; 175:108796. [PMID: 33845051 DOI: 10.1016/j.diabres.2021.108796] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 12/17/2022]
Abstract
Sodium-glucose transporter-2 inhibitors (SGLT2i), originally launched as glucose-lowering drugs, have been studied in large cardiovascular outcome trials to ascertain safety. Surprisingly, these compounds reduced the risk of cardiovascular events (cardiovascular death, non-fatal myocardial and non-fatal stroke) and total mortality. The mechanisms behind this benefit are only partly understood, but a major contributor is the reduction of heart failure hospitalisations, evident already within weeks after the initiation of the SGLT2i. SGLT2 inhibition increases urinary glucose excretion, thereby improving glycaemic control in an insulin-independent manner. Moreover, SGLT2i potentially impact the cardiovascular system both indirectly via weight loss and blood pressure lowering and directly through osmotic diuresis and increased sodium excretion and presumably by improving myocardial energetics. The aim of this review is to summarise evidence from all major outcome trials investigating SGLT2i in patients with diabetes, as well as recent evidence from trials in heart failure patients without glucose perturbations, which pave the way for novel treatment of large groups of patients. The results of these studies have been taken into account in recently issued guidelines for the management of diabetes and cardiovascular disease. An important task for diabetologists, cardiologists and general practitioners is to incorporate them into clinical practice to the benefit of many patients.
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Affiliation(s)
- Giulia Ferrannini
- Department of Medicine K2, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Gianluigi Savarese
- Department of Medicine K2, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institutet, 171 76 Stockholm, Sweden.
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Nochioka K, Sakata Y, Miura M, Shiroto T, Takahashi J, Saga C, Ikeno Y, Shiba N, Shinozaki T, Sugi M, Nakagawa M, Komaru T, Kato A, Nozaki E, Iwabuchi K, Hiramoto T, Inoue K, Ohe M, Tamaki K, Tsuji I, Shimokawa H. Impaired glucose tolerance and albuminuria in patients with chronic heart failure: a subanalysis of the SUPPORT trial. ESC Heart Fail 2019; 6:1252-1261. [PMID: 31647614 PMCID: PMC6989294 DOI: 10.1002/ehf2.12516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 06/30/2019] [Accepted: 08/16/2019] [Indexed: 01/14/2023] Open
Abstract
AIMS The study aims to evaluate the prognostic significance of impaired glucose tolerance (IGT) with reference to albuminuria in patients with chronic heart failure (CHF). METHODS AND RESULTS We examined 535 CHF patients (mean 66 years, women 25%) in the control arm of our SUPPORT trial, in which we examined additive impact of olmesartan in hypertensive patients with symptomatic CHF treated with β-blockers and/or angiotensin-converting enzyme inhibitors. We examined the association between glycaemic abnormality (assessed by 75 g of oral glucose tolerance test) and albuminuria for a composite outcome of all-cause death, myocardial infarction, stroke, and HF hospitalization. IGT patients (N = 113, mean 67.2 years) were older and more frequently treated with β-blockers compared with those with normal glucose regulation (N = 142, mean 64.0 years) and those with diabetes mellitus (N = 280, mean 65.7 years). Multivariable Cox proportional hazard models revealed that, as compared with normal glucose regulation (NGR), IGT was associated with increased risk of the outcome when complicated by albuminuria [hazard ratio (HR) 2.25; 95% confidence interval (CI) 1.14-4.42; P = 0.019] but not when uncomplicated by albuminuria (HR 0.76; 95% CI 0.35-1.60, P = 0.47) (P for interaction = 0.041). This was also the case for diabetes mellitus and albuminuria (HR 2.06; 95% CI 1.17-3.61; P = 0.012). Among IGT patients without albuminuria, 21 (29%) developed albuminuria at 1-year visit, which was again associated with poor prognosis (HR 7.36; 95% CI 1.39-38.98, P = 0.019). CONCLUSIONS These results indicate that IGT is associated with poor prognosis when complicated by albuminuria in CHF patients, demonstrating the importance of combined early stages of glucose intolerance and renal dysfunction in the management of CHF.
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Grants
- Ministry of Health, Labour and Welfare, Japan
- Ministry of Education, Culture, Sports, Science and Technology
- Ministry of Health, Labour and Welfare, Japan
- Ministry of Education, Culture, Sports, Science and Technology
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Affiliation(s)
- Kotaro Nochioka
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSeiryo‐machi 1–1SendaiMiyagi980–8574Japan
| | - Yasuhiko Sakata
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSeiryo‐machi 1–1SendaiMiyagi980–8574Japan
| | - Masanobu Miura
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSeiryo‐machi 1–1SendaiMiyagi980–8574Japan
| | - Takashi Shiroto
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSeiryo‐machi 1–1SendaiMiyagi980–8574Japan
| | - Jun Takahashi
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSeiryo‐machi 1–1SendaiMiyagi980–8574Japan
| | - Chie Saga
- Department of Evidence‐based Cardiovascular MedicineTohoku University Graduate School of MedicineMiyagiJapan
| | - Yasuko Ikeno
- Department of Evidence‐based Cardiovascular MedicineTohoku University Graduate School of MedicineMiyagiJapan
| | - Nobuyuki Shiba
- Department of Cardiovascular MedicineInternational University of Health and Welfare HospitalTochigiJapan
| | - Tsuyoshi Shinozaki
- Cardiovascular Division, Sendai Medical CenterNational Hospital OrganizationMiyagiJapan
| | - Masafumi Sugi
- Cardiovascular Division, Iwaki City Medical CenterFukushimaJapan
| | - Makoto Nakagawa
- Department of Cardiovascular MedicineIwate Prefectural Isawa HospitalIwateJapan
| | - Tatsuya Komaru
- Department of Cardiovascular MedicineTohoku Medical and Pharmaceutical UniversityMiyagiJapan
| | - Atsushi Kato
- Department of Cardiovascular MedicineSendai Open HospitalMiyagiJapan
| | - Eiji Nozaki
- Department of Cardiovascular MedicineIwate Prefectural Central HospitalIwateJapan
| | - Kaoru Iwabuchi
- Cardiovascular DivisionOsaki Citizen HospitalMiyagiJapan
| | | | - Kanichi Inoue
- Cardiovascular DivisionSenen Rifu HospitalMiyagiJapan
| | - Masatoshi Ohe
- Cardiovascular DivisionKojirakawa Shieido HospitalMiyagiJapan
| | - Kenji Tamaki
- Cardiology DepartmentIwate Health Service AssociationIwateJapan
| | - Ichiro Tsuji
- Division of Epidemiology, Department of Public Health and Forensic MedicineTohoku University Graduate School of MedicineMiyagiJapan
| | - Hiroaki Shimokawa
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSeiryo‐machi 1–1SendaiMiyagi980–8574Japan
- Department of Evidence‐based Cardiovascular MedicineTohoku University Graduate School of MedicineMiyagiJapan
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