Abstract
BackgroundType 2 diabetes mellitus (T2D) is associated with the development of left ventricular systolic dysfunction (LVSD) and heart failure with reduced ejection fraction (HFrEF). T2D patients with LVSD are at higher risk of mortality and morbidity than patients without LVSD, while progression of LVSD can be delayed or halted by the use of proven therapies. As estimates of the prevalence are scarce and vary considerably, the aim of this study was to retrieve summary estimates of the prevalence of LVSD/HFrEF in T2D and to see if there were any sex differences.MethodsA systematic search of Medline and Embase was performed to extract the prevalence of LVSD/HFrEF in T2D (17 studies, mean age 50.1 ± 6.3 to 71.5 ± 7.5), which were pooled using random-effects meta-analysis.ResultsThe pooled prevalence of LVSD was higher in hospital populations (13 studies, n = 5835, 18% [95% CI 17–19%]), than in the general population (4 studies, n = 1707, 2% [95% CI 2–3%]). Seven studies in total reported sex-stratified prevalence estimates (men: 7% [95% CI 5–8%] vs. women: 1.3% [95% CI 0.0.2.2%]). The prevalence of HFrEF was available in one general population study (5.8% [95% CI 3.7.6%], men: 6.8% vs. women: 3.0%).ConclusionsThe summary prevalence of LVSD is higher among T2D patients from a hospital setting compared with from the general population, with a higher prevalence in men than in women in both settings. The prevalence of HFrEF among T2D in the population was only assessed in a single study and again was higher among men than women.
Highlights
Type 2 diabetes mellitus (T2D) is a major risk factor for all types of heart failure (HF) and causes an increase in mortality and morbidity in patients with HF [1]
Selection of articles The following predefined inclusion criteria were applied: (i) The study reported the prevalence of heart failure with reduced ejection fraction (HFrEF) and/or left ventricular systolic dysfunction (LVSD) in patients with T2D. (ii) The study population was derived from the population at large or from the hospital population. (iii) Only studies were included that used echocardiography to establish or confirm the diagnosis of HFrEF and/or LVSD. (iv) T2D defined by one of the following criteria: documentation in the medical record, physicians diagnosis, self-reported history, use of antidiabetic agents and random serum glucose ≥ 200 mg/dL or serum fasting glucose ≥ 126 mg/ dL
The main reasons for exclusion included the lack of T2D in the population, no information regarding HF or LVSD/HFrEF and lack of echocardiographic data
Summary
Type 2 diabetes mellitus (T2D) is a major risk factor for all types of heart failure (HF) and causes an increase in mortality and morbidity in patients with HF [1]. The risk of all-cause mortality and cardiac hospitalization remains high and some studies report higher rates in HFrEF patients than in patients with heart failure with preserved ejection fraction (HFpEF) [8]. Given the high prevalence of (unrecognized) HFrEF in T2D patients, the poor prognosis and available effective therapies, the implementation of screening-programmes in T2D patients with natriuretic peptides has been suggested to identify LV dysfunction in its pre-clinical phase [11]. Previous studies regarding prevalence rates of LVSD in T2D did not look at HFrEF and HFpEF separately, and only looked at T2D patients in secondary care and not from the general population. T2D patients with LVSD are at higher risk of mortality and morbidity than patients without LVSD, while progression of LVSD can be delayed or halted by the use of proven therapies. As estimates of the prevalence are scarce and vary considerably, the aim of this study was to retrieve summary estimates of the prevalence of LVSD/HFrEF in T2D and to see if there were any sex differences
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