Abstract 17631: Diabetic Retinopathy and Risk of Heart Failure Subtypes: The Atherosclerosis Risk in Communities (ARIC) Study

Abstract

Introduction: Although diabetic retinopathy is associated with higher risk of incident heart failure (HF), its associations with HF subtypes (HF with preserved ejection fraction [HFpEF] and HF with reduced ejection fraction [HFrEF]) largely remain unknown. Hypothesis: Diabetic retinopathy, a microvascular complication of hyperglycemic states, is more strongly associated with HFpEF than with HFrEF. Methods: We included 5038 ARIC participants who underwent fundus photography at Visit 3 (1993-1995), had diabetes or prediabetes, and were free of HF (mean age 60 years, 48% women, 27% Black adults). Retinopathy was graded according to the Early Treatment of Diabetic Retinopathy Study (ETDRS) grading scale, with a severity score ≥14 defining the presence of any retinopathy. We used data on incident HF hospitalization. Information on HF subtypes was only available from 2005 onwards. We used Cox regression to estimate the associations of retinopathy with incident overall HF. For HF subtypes, to account for the competing risks of HFpEF and HFrEF, we used competing risks regression analysis by the proportional sub-hazards Fine and Gray method. Results: Over a median 21.2 years of follow-up, there were 1358 HF events (461 prior to 2005 and 897 post-2005 [including 418 HFpEF and 383 HFrEF]). The presence of diabetic retinopathy conferred higher risk of overall HF (hazard ratio [HR]: 1.84, 95% confidence interval [CI]: 1.55, 2.20). Among participants with information on HF subtypes post-2005 (n= 4120), diabetic retinopathy significantly increased the risk of HFpEF (HR 1.86, 95% CI: 1.28, 2.71), but not of HFrEF (sub-HR: 0.73, 95% CI: 0.45, 1.20). An increasing severity of diabetes retinopathy was associated with increasing risks of overall HF and HFpEF. Conclusions: The presence of diabetic retinopathy signifies an excess risk of HF, primarily HFpEF. Our findings support a strong contribution of microvascular disease to the development of HFpEF.