Ingrid E M Bank1, Crystel M Gijsberts2, Tiew-Hwa K Teng3, Lina Benson4, David Sim3, Poh Shuan Daniel Yeo5, Hean Yee Ong6, Fazlur Jaufeerally7, Gerard K T Leong8, Lieng H Ling9, A Mark Richards10, Dominique P V de Kleijn11, Ulf Dahlström12, Lars H Lund13, Carolyn S P Lam14. 1. Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands. 2. Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; ICIN-Netherlands Heart Institute, Utrecht, the Netherlands. 3. National Heart Center, Singhealth, Singapore. 4. Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden. 5. Department of Cardiology, Tan Tock Seng Hospital, Singapore. 6. Department of Cardiology, Khoo Teck Puat Hospital, Singapore. 7. Department of Medicine/Cardiology, Singapore General Hospital, Singapore. 8. Department of Cardiology, Changi General Hospital, Singapore. 9. Yong Loo Lin School of Medicine, National University, Singapore; Cardiac Department, National University Health System, Singapore. 10. Cardiovascular Research Institute, National University, Singapore, Singapore; Christchurch Heart Institute, University of Otago, Christchurch, New Zealand. 11. Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Yong Loo Lin School of Medicine, National University, Singapore. 12. Department of Cardiology and Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden. 13. Department of Medicine and Department of Cardiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. Electronic address: lars.lund@alumni.duke.edu. 14. National Heart Center, Singhealth, Singapore; Yong Loo Lin School of Medicine, National University, Singapore; Cardiovascular Research Institute, National University, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore. Electronic address: carolyn.lam@duke-nus.edu.org.
Abstract
OBJECTIVES: The study sought to compare the prevalence, clinical correlates and prognostic impact of diabetes in Southeast Asian versus white patients with heart failure (HF) with preserved or reduced ejection fraction. BACKGROUND: Diabetes mellitus is common in HF and is associated with impaired prognosis. Asia is home to the majority of the world's diabetic population, yet data on the prevalence and clinical significance of diabetes in Asian patients with HF are sparse, and no studies have directly compared Asian and white patients. METHODS: Two contemporary population-based HF cohorts were combined: from Singapore (n = 1,002, median [25th to 75th percentile] age 62 [54 to 70] years, 76% men, 19.5% obesity) and Sweden (n = 19,537, 77 [68 to 84] years, 60% men, 24.8% obesity). The modifying effect of ethnicity on the relationship between diabetes and clinical correlates or prognosis (HF hospitalization and all-cause mortality) was examined using interaction terms. RESULTS: Diabetes was present in 569 (57%) Asian patients versus 4,680 (24%) white patients (p < 0.001). Adjusting for clinical covariates, obesity was more strongly associated with diabetes in white patients (odds ratio [OR]: 3.45; 95% confidence interval [CI]: 2.86 to 4.17) than in Asian patients (OR: 1.82; 95% CI: 1.13 to 2.96; pinteraction = 0.026). Diabetes was more strongly associated with increased HF hospitalization and all-cause mortality in Asian patients (hazard ratio: 1.50; 95% CI: 1.21 to 1.87) than in white patients (hazard ratio: 1.29; 95% CI: 1.22 to 1.36; pinteraction = 0.045). CONCLUSIONS: Diabetes was 3-fold more common in Southeast Asian compared to white patients with HF, despite younger age and less obesity, and more strongly associated with poor outcomes in Asian patients than white patients. These results underscore the importance of ethnicity-tailored aggressive strategies to prevent diabetes and its complications.
OBJECTIVES: The study sought to compare the prevalence, clinical correlates and prognostic impact of diabetes in Southeast Asian versus white patients with heart failure (HF) with preserved or reduced ejection fraction. BACKGROUND:Diabetes mellitus is common in HF and is associated with impaired prognosis. Asia is home to the majority of the world's diabetic population, yet data on the prevalence and clinical significance of diabetes in Asian patients with HF are sparse, and no studies have directly compared Asian and white patients. METHODS: Two contemporary population-based HF cohorts were combined: from Singapore (n = 1,002, median [25th to 75th percentile] age 62 [54 to 70] years, 76% men, 19.5% obesity) and Sweden (n = 19,537, 77 [68 to 84] years, 60% men, 24.8% obesity). The modifying effect of ethnicity on the relationship between diabetes and clinical correlates or prognosis (HF hospitalization and all-cause mortality) was examined using interaction terms. RESULTS:Diabetes was present in 569 (57%) Asian patients versus 4,680 (24%) white patients (p < 0.001). Adjusting for clinical covariates, obesity was more strongly associated with diabetes in white patients (odds ratio [OR]: 3.45; 95% confidence interval [CI]: 2.86 to 4.17) than in Asian patients (OR: 1.82; 95% CI: 1.13 to 2.96; pinteraction = 0.026). Diabetes was more strongly associated with increased HF hospitalization and all-cause mortality in Asian patients (hazard ratio: 1.50; 95% CI: 1.21 to 1.87) than in white patients (hazard ratio: 1.29; 95% CI: 1.22 to 1.36; pinteraction = 0.045). CONCLUSIONS:Diabetes was 3-fold more common in Southeast Asian compared to white patients with HF, despite younger age and less obesity, and more strongly associated with poor outcomes in Asian patients than white patients. These results underscore the importance of ethnicity-tailored aggressive strategies to prevent diabetes and its complications.
Keywords:
diabetes mellitus; global disease patterns; global health; heart failure with preserved ejection fraction; heart failure with reduced ejection fraction
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