Heart Failure Epidemiology in Patients With Diabetes Mellitus Without Coronary Heart Disease

Background: Epidemiology of patients with comorbid heart failure (HF) and diabetes mellitus (DM) without coronary heart disease (CHD) is not well described. Methods and Results: We assessed HF incidence and outcomes in 2896 participants of the Health ABC Study (age 74.0 +/- 3.0 years, 48.4% men, 41.1% black, 34.6% with DM) in relation to prio DM and CHD status. During a median follow-up of 11.4 years, 484 participants (16.7%) developed incident HF; 214 (44.2%) had DM of whom 71 (33.1%) had no prio CHD. Incident HF rate was 2.5% per 100 person-years in those with and 1.5% in those without DM (hazard ratio [HR] 1.66, 95% CI 1.39-1.99). In those with DM, incident HF rate was 4.6% in those with and 1.3% in those without CHD (HR 3.75, 95% CI 2.81-4.99). During a median follow-up of 2.1 years after HF onset, 329 (68.0%) of the participants died. Amongst those with DM, annual mortality was 22.6% in those with versus 25.9% without CHD (HR 0.86, 95% CI 0.61-1.22). All-cause hospitalizations after incident HF in DM patients were 55.0 per 100 person years in those with and 33.3 in those without CHD (rate ratio [RR] 1.64, 95% CI 1.24-2.16); HF hospitalizations were 42.7 and 30.7 per 100-person years (RR 1.39, 95% CI 1.03-1.86) in those with and without CHD. Reduced ejection fraction was seen in 49.6% of HF patients with DM and CHD and in 34.7% of those without CHD (P = .08); mortality but not hospitalization risk tended to be lower in those with reduced compared with preserved ejection fraction regardless of CHD status. Conclusions: A sizeable proportion of HF in patients with DM develops in the absence of prior CHD; these patients are at risk for mortality similar to those with CHD. These data underscore the importance of modulating risk beyond atherosclerosis in patients with comorbid HF and DM.