Kristensen SL, et al. - This study assessed the prevalence as well as associated clinical outcomes of prediabetic dysglycemia and undiagnosed diabetes in patients with heart failure (HF) and preserved ejection fraction (HFpEF) and heart failure and reduced ejection fraction (HFrEF). Findings confirmed that regardless of ejection fraction phenotype, there was a remarkably high prevalence of dysglycemia in heart failure patients. Notably, in patients with HFpEF as well as HFrEF, dysglycemia was found to be related to a higher risk of adverse clinical outcomes, even before the diagnosis of diabetes and institution of glucose lowering therapy.

Methods

• Researchers assessed the prevalence and outcomes related to normoglycemia, prediabetic dysglycemia and diabetes (diagnosed and undiagnosed) among individuals with a baseline glycated hemoglobin (hemoglobin A1c, HbA1c) measurement stratified by HFrEF or HFpEF in the Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity programme (CHARM).
• They studied the primary outcome of HF hospitalization or cardiovascular (CV) death, and all-cause death, and using multivariable Cox regression models , estimated hazard ratios (HR).

Results

• Data reported that HbA1c was measured at baseline in CHARM patients enrolled in the USA and Canada and was available in 1072/3023 (35%) of patients with HFpEF and 1578/4576 (34%) patients with HFrEF.
• Researchers found that 18 and 16% had normoglycemia (HbA1c < 6.0), 20 and 22% had prediabetes (HbA1c 6.0–6.4), respectively.
• Findings demonstrated that among patients with HfpEF, 22% had undiagnosed diabetes (HbA1c > 6.4), and 40% had known diabetes (any HbA1c), with corresponding prevalence among HFrEF patients being 26 and 35%.
• In addition, patients with undiagnosed diabetes and prediabetes versus normoglycemic patients had higher rates of both clinical outcomes of interest, irrespective of HF subtype, and these rates were in general higher among HFrEF patients.
• It was also noted that for the primary composite outcome among HFpEF patients, the HRs were 1.02 (95% CI 0.63–1.65) for prediabetes, HR 1.18 (0.75–1.86) for undiagnosed diabetes and 2.75 (1.83–4.11) for known diabetes, respectively, p value for trend across groups < 0.001.
• An association was evident, between dysglycemia and worse outcomes in HFrEF.