Abstract 16177: Race and Sex-specific Long-term Risk of Incident Heart Failure in Adults Stratified by Fasting Glucose Level: Lifetime Risk Pooling Project

Abstract

Introduction: While the association of diabetes with heart failure (HF) is well-established, the long-term risk (LR) of incident HF with prediabetes across the life course is not known. Furthermore, race-sex disparities in LR of HF across categories of fasting plasma glucose (FPG) has not been described. To inform HF preventive strategies, we compared the race- and sex-specific LR of HF across categories of FPG in adults. Methods: Individual-level data from adults free of baseline HF was pooled from 6 population-based cohorts stratified by baseline age (40-59, 60-79 years) and race-sex groups. We defined FPG status as normal (<100 mg/dL), prediabetes (FPG 100-125 mg/dL) and diabetes (FPG ≥126 mg/dL or use of antihyperglycemic agents). Modified Kaplan-Meier analysis was performed by FPG strata to estimate the LR of HF (30-year in middle-aged and 20-year in older adults) adjusted for the competing risk of non-HF death. We estimated adjusted hazard ratios (aHR) for HF in each FPG strata using Cox proportional regression models. Results: Of the 40,117 participants, 24% were black and 56% were women. During 638,910 person-years of follow-up, there were 4,846 cases of incident HF. In middle-aged adults, the LR of HF was significantly higher among individuals with prediabetes (6.1 [4.8, 7.4] to 14.4 [9.6, 19.2]%) compared with normal FPG (3.5 [3.0, 4.1] to 11.7 [9.1, 14.3]%). In older adults with prediabetes compared with normal FPG, LR of HF was significantly higher in white men (13.5 [12.0, 14.9]% vs 10.4 [9.2, 11.6]%) and women (12.2 [10.8, 13.6]% vs 7.8 [6.9, 8.7]%) but not in black men (12.2 [9.0, 15.3]% vs 14.6 [11.6, 17.6]%) or women (13.5 [10.1, 16.8]% vs 11.7 [9.4, 14.0]%). Race-sex specific aHR for HF across FPG strata are shown in the table. Conclusions: Compared with normal FPG, prediabetes was associated with significantly greater LR of HF in middle-aged but not in older adults. Of all groups, black women with diabetes qualitatively had a disproportionately higher LR of HF.