Diabetes a risk factor for heart failure post-MI

Patients with diabetes are more likely to have an increased risk of developing heart failure (HF) after an acute myocardial infarction (MI) compared with those without diabetes, according to the Fast-MI* study presented at ESC 2019.

Using data from the nationwide French registries from 2005–2015, the researchers identified 13,130 patients with an acute STEMI** or NSTEMI***. Participants were divided into three populations: first population (n=12,473; diabetic [n=3,024] and nondiabetic [n=9,449]), second population (n=9,181; diabetic [n=2,025] and those who were discharged alive), and third population (n=5,167; diabetic patients [n=1,183] with nonfatal HF [mean age 71 years, 44 percent female] and without nonfatal HF [mean age 67 years, 26 percent female] who were alive at 1 year). [ESC 2019, abstract 5904]

In the first population, a significant increased risk of HF was observed among patients with diabetes vs those without, regardless of whether they had previously received insulin treatment (adjusted odds ratio [adjOR], 2.11; p<0.001) or they had not (adjOR, 1.49; p<0.001).

Significantly more diabetic patients also had a Killip class ≥II during their initial hospitalization than nondiabetic patients (29 percent vs 15.3 percent, adjOR, 1.64; p<0.001).

When Killip classification was further assessed, patients with diabetes demonstrated a higher risk than those without diabetes for each Killip class: Killip classes II (12.6 percent vs 7.8 percent), III (11.0 percent vs 4.3 percent), and IV (5.4 percent vs 3.1 percent).

In the second population, patients with diabetes had a significantly increased risk of death or HF within 1 year compared with those without diabetes (8.8 percent vs 3.7 percent, adjusted hazard ratio [adjHR], 1.60; p<0.001).

In addition, a higher risk of death or HF was observed among diabetic patients who were treated with insulin than those who were not (adjHR, 2.09; p<0.001 vs 1.35; p=0.013).

Diabetic patients also showed a significantly increased risk of hospital admission for nonfatal HF within 1 year than the nondiabetic patients (3.2 percent vs 1.2 percent, adjHR, 1.70; p=0.002).

Similarly, a higher risk of hospital admission for nonfatal HF was observed among diabetic patients who received insulin therapy compared with those who did not (adjHR, 2.80; p=0.002 vs 1.19; p=0.433).

With regard to the third population, a significantly higher rate of 5-year mortality was observed among diabetic patients who had been hospitalized for nonfatal HF during the first year following an acute MI (40.0 percent vs 14.5 percent, adjHR, 2.02; p=0.014) compared with patients without nonfatal HF.

Overall, a statistically significant increase in the risk of 5-year mortality was observed among all patients with diabetes but no HF (adjHR, 1.44; p=0.001), and those patients with both diabetes and HF had an almost threefold increased risk of 5-year mortality (adjHR, 2.94; p<0.001).

“Our study shows that diabetes is associated with a considerably increased risk of developing HF after a heart attack. Furthermore, diabetic patients who develop HF in the year after a heart attack have a much higher risk of dying in the following years,” said lead author Prof Nicolas Danchin from European Hospital Georges Pompidou in Paris, France.

“More efforts are needed to prevent diabetes. In addition, better management is required for diabetic patients who have a heart attack to avoid HF and its detrimental long-term consequences,” he added.

*Fast-MI: French Registry of Acute Coronary Syndrome

**STEMI: ST elevation myocardial infarction

***NSTEMI: Non-ST elevation myocardial infarction