Abstract
Background: The impact of diabetes mellitus (DM) for patients with heart failure and preserved left ventricle ejection fraction (HFpEF) remains unclear. We aimed to determine the impact of DM on the prognosis of patients with DM and HFpEF enrolled in the TOPCAT trial. Methods: We classified TOPCAT patients into three groups: insulin-dependent DM (IDDM), non-insulin dependent DM (NIDDM) and non-DM. We investigated the occurrence of a major adverse cardiovascular event (MACE), defined as CV mortality, hospitalization for HF, non-fatal myocardial infarction (MI), non-fatal non-hemorrhagic stroke, or aborted cardiac arrest. Secondary outcomes included the individual components of MACE and all-cause mortality. We used multivariate Cox proportional hazards regression models to evaluate the independent associations of DM on time to MACE. Results: There were 1,134 DM patients (439 IDDM and 695 NIDDM) and 2,307 non-DM patients. The IDDM patients were younger and more likely to be male, non-white, and from the Americas. Despite having the highest median left ventricle’s ejection fraction (LVEF) (58%) compared to NIDDM and non-DM patients (57% and 56%, respectively, p=0.007), they were more symptomatic. Forty-eight percent of IDDM patients were of New York Heart Association (NYHA) III/IV functional classes compared to 36% of NIDDM and 29% of non-DM patients (p<0.001). IDDM patients had significantly increased risks for MACE, CV mortality, MI, HF hospitalization, and all-cause mortality when compared to non-DM patients (p-values<0.01). NIDDM patients had similar risks for MACE and the secondary outcomes as the non-DM patients. The effect of diabetes on outcomes was similar between regions. Conclusion: Among HFpEF patients, IDDM but not NIDDM was independently associated with increased risks of MACEs. Future research is needed to evaluate whether optimal medications and lifestyle interventions may reduce MACE in these high-risk patients.
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