ARIC: Uncontrolled diabetes ups risk of heart failure progression in older adults

Uncontrolled diabetes among older adults with preclinical heart failure (HF) stages appears to increase the risk of HF progression, suggests a study.

A total of 4,774 adults (mean age 75.4 years, 58 percent women) with preclinical HF (stage A, n=1,551 or stage B, n=3,223) who attended the Atherosclerosis Risk In Communities (ARIC) study visit 5 (2011‒2013) were included in this study, which sought to characterize the influence of diabetes on the progression from preclinical HF stages (A or B based on the 2021 Universal Definition) to overt HF.

The authors evaluated within each stage the association of diabetes and glycaemic control (haemoglobin A1c [HbA1c] <7 percent vs ≥7 percent) with progression to HF, as well as that of cross-categories of HF stage, diabetes, and glycaemic control with incident HF.

A total of 470 HF events occurred among participants during 8.6 years of follow-up. Stage B participants with HbA1c ≥7 percent had clinical HF at a younger age compared to those with controlled or without diabetes (mean age 80 vs 83 vs 82 years; p<0.001).

HbA1c ≥7 percent showed a more robust correlation with HF in stage B (hazard ratio [HR], 1.83, 95 percent confidence interval [CI], 1.33‒2.51) than in stage A (HR, 1.52, 95 percent CI, 0.53‒4.38).

In cross-categories of preclinical HF stage and HbA1c, participants with stage B and HbA1c ≥7 percent had an increased HF progression risk relative to those with stage A without diabetes (HR, 7.56, 95 percent CI, 4.68‒12.20).

“Our results suggest that targeting diabetes early in the HF process is critical,” the authors said.