Vuori MA, Reinikainen J, Söderberg S, et al. - Obesity, hyperglycemia, and cardiac strain/volume overload were identified as the main mediators of heart failure in diabetes. Improved prevention and prediction of heart failure in high-risk diabetic patients may potentially be achieved via active measurement of relevant biomarkers.

• This study included 3,834 diabetic and 90,177 non-diabetic people to examine the association of conventional heart failure risk factors and biomarkers with incident heart failure.

• In diabetic persons, the estimated multivariable-adjusted hazard ratio (HR) for heart failure was 2.70 relative to non-diabetic participants.

• A strong association of conventional cardiovascular risk factors (such as smoking, BMI, baseline myocardial infarction, and baseline atrial fibrillation) with incident heart failure was evident, but these links were not stronger in diabetic vs in non-diabetic people.

• Additionally, biomarkers for cardiac strain (diabetes: HR 1.26; non-diabetes: HR 1.43), myocardial injury (diabetes: HR 1.10; non-diabetes: HR 1.13), and inflammation (diabetes: HR 1.13; non-diabetes: HR 1.29) were also found to be related to incident heart failure.