Abstract P436: Pre-Diabetes With and Without Cardiac Dysfunction and the Risk of Heart Failure in Older Adults

Abstract

Background: Whether pre-diabetes (pre-DM) is independently associated with the risk of heart failure (HF) in the elderly remains inconclusive. Objective: To examine the prevalence of cardiac dysfunction in pre-DM and the prognostic differences of HF in pre-DM with and without cardiac dysfunction in a diverse elderly population. Methods: We included HF-free individuals with euglycemia (n=770) or pre-DM (n=2157) who underwent echocardiography at the Atherosclerosis Risk in Communities (ARIC) Study Visit 5 (baseline). A composite cardiac dysfunction measure included ≥2 echocardiographic abnormalities (Left ventricular hypertrophy [LV mass index ≥115 g/m 2 in men or≥95 g/m 2 in women], left atrial enlargement [LA volume index ≥34 mL/m 2 ], diastolic dysfunction [E/e’ >13, E/A>2, or E-wave deceleration time >240 ms], and systolic dysfunction [ejection fraction<45%]) and high NT pro-BNP (>125 pg/mL in obese or >100 in non-obese). Our outcome was a new diagnosis of definite or probable acute decompensated HF. We assessed the prevalence of the composite cardiac dysfunction in pre-DM (fasting glucose 100-125 mg/dL or HbA1c 5.7-6.4%) and the association between pre-DM and incident HF with and without cardiac dysfunction at baseline adjusting for age, sex, race, center, education, smoking, BMI, systolic blood pressure, total cholesterol, hypertensive medication, lipid-lowering medication, and eGFR (CKD-EPI) in the Cox regression models. Results: 9.5% of elderly individuals with pre-DM had cardiac dysfunction. In a median follow-up of 7 years, compared to euglycemia without cardiac abnormalities, we found a significant risk of HF in pre-DM with cardiac dysfunction (HR 2.6, 95% CI 1.6-4.5) but not in pre-DM without cardiac dysfunction (0.8, 0.5-1.2). The finding was consistent in sex and race groups and sensitivity analyses excluding those with a history of hypertension or obesity. Conclusion: Pre-DM is associated with an increased risk of HF in elderly people, but the risk was only significant among those with cardiac dysfunction.