Association of baseline and longitudinal changes in cardiometabolic health with risk of heart failure among adults with type 2 diabetes: an analysis from the Look AHEAD trial

Abstract

Abstract Background Type 2 diabetes (T2D) is characterized by co-morbid cardiometabolic abnormalities and elevated heart failure (HF) risk. Purpose The purpose of this study was to evaluate the associations of baseline and longitudinal changes in cardiometabolic health with risk of HF among adults with T2D. Methods Adults with T2D enrolled in the Look AHEAD (Action for Health in Diabetes) trial without prevalent HF were included. Adjusted Cox models were used to create a cardiometabolic health score incorporating target levels of parameters weighted based on relative risk for HF. The associations of baseline, 1- and 4-year changes in the cardiometabolic health score with risk of overall HF, HF with preserved ejection fraction (HFpEF; EF≥50%), and HF with reduced EF (HFrEF; EF<50%) were assessed using adjusted Cox models. Results Of the 5,080 participants included, there were 257 incident HF events during 12.4-year follow-up. The cardiometabolic health score included 2-points each for target levels of waist circumference, glomerular filtration rate, urine albumin-to-creatinine ratio and 1-point each for blood pressure and hemoglobin A1c at target (Table 1). Higher baseline cardiometabolic health score was significantly associated with lower risk of overall HF (adjusted hazard ratio [aHR] per 1-unit higher score, 0.72 [95% CI, 0.66–0.79]) with similar associations observed for HFpEF and HFrEF (Table 2). Improvement in cardiometabolic health over 1- and 4-years was significantly associated with lower risk of overall HF (aHR per 1-unit increase in score at 1- and 4-years, 0.82 [95% CI, 0.73–0.92] and 0.80 [95% CI, 0.70–0.91], respectively). Conclusions Among adults with T2D, achieving target levels of more cardiometabolic health parameters at baseline and sustained improvements were associated with lower HF risk. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Diabetes and Digestive and Kidney Diseases