Abstract P134: Bidirectional Association of Diabetes and Heart Failure

Abstract

Background: Diabetes and heart failure (HF) frequently coexist. Diabetes is a major risk factor for HF, but physiological studies have also shown that HF promotes insulin resistance, and thus may predispose to diabetes. However, the bidirectional association between diabetes and HF has seldom been examined in community-based studies. Methods: We conducted a prospective analysis of 10982 individuals (mean age 63.3 years, 56% women, ~22% Black adults, 1822 [16.6%] with prevalent diabetes and 606 [5.5%] with prevalent HF) who attended Visit 4 (1996-1998) of the Atherosclerosis Risk in Communities (ARIC) Study. We used Cox regression to examine the association of prevalent HF at Visit 4 or incident HF after Visit 4 with the incidence of diabetes, as well as the association of prevalent diabetes at Visit 4 or incident diabetes after Visit 4 with the incidence of HF. We also assessed individual and joint associations of diabetes and HF at Visit 4 with mortality. Results: Of the 606 individuals with prevalent HF by Visit 4, more than half (52.3%) had or developed diabetes. Among 1822 individuals with prevalent diabetes at Visit 4, 44% had a history of HF. Prevalent HF (hazard ratio [HR]: 1.34, 95%CI: 1.09, 1.64; no HF as referent) and incident HF (HR: 1.32, 95%CI: 1.08, 1.61) were each associated with incident diabetes. Prevalent diabetes (HR, 1.83; 95% CI, 1.64, 2.03; no diabetes as referent) and incident diabetes (HR: 1.37, 95%CI: 1.21, 1.56) were each associated with incident HF. The presence of both prevalent HF and diabetes conferred greater overall mortality (HR: 2.59, 95% CI: 2.22, 3.02) and cardiovascular mortality (HR: 3.82, 95% CI: 3.06, 4.78) risks compared with the absence of both conditions or either condition alone. Conclusions: Diabetes precedes and follows HF, with each condition being a risk factor for the other. The coexistence of both diabetes and HF is associated with a markedly elevated risk of mortality.