Chanchal Chandramouli1, Tiew-Hwa Katherine Teng1, Wan Ting Tay1, Jonathan Yap1, Michael R MacDonald2, Jasper Tromp1,3, Limin Yan1, Bambang Siswanto4, Eugenio B Reyes5, Tachapong Ngarmukos6, Cheuk-Man Yu7, Chung-Lieh Hung8, Inder Anand9, A Mark Richards10,11,12, Lieng Hsi Ling10, Judith G Regensteiner13, Carolyn S P Lam1,3,14. 1. National Heart Centre Singapore, Singapore. 2. Changi General Hospital, Singapore. 3. Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands. 4. National Cardiovascular Center Universitas Indonesia, Jakarta, Indonesia. 5. Manila Doctors Hospital, Manila, Philippines. 6. Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 7. Hong Kong Baptist Hospital, The Chinese University of Hong Kong, Hong Kong, The People's Republic of China. 8. Mackay Memorial Hospital, Taiwan, ROC. 9. Veterans Affairs Medical Center, Minneapolis, MN, USA. 10. Cardiovascular Research Institute, Singapore. 11. National University of Singapore, Singapore. 12. Christchurch Heart Institute, University of Otago, Otago, New Zealand. 13. University of Colorado School of Medicine, Aurora, CO, USA. 14. Duke-National University of Singapore, Singapore.
Abstract
AIMS: To examine sex differences in clinical characteristics, echocardiographic features, quality of life and 1-year death or heart failure (HF) hospitalization outcomes in patients with/without diabetes mellitus (DM). METHODS AND RESULTS: Utilizing the Asian Sudden Cardiac Death in HF (ASIAN-HF) registry, 5255 patients (mean age 59.6 ± 13.1, 78% men) with symptomatic HF with reduced ejection fraction (HFrEF) were stratified by DM status to address the research aims. Despite similar prevalence of DM between Asian men (43%) and women (42%), the odds of DM increased at lower body mass index in women vs. men (≥ 23 vs. ≥ 27.5 kg/m2 , Pinteraction = 0.014). DM was more strongly related to chronic kidney disease in women vs. men [adjusted odds ratio (OR) 1.85, 95% confidence interval (CI) 1.33-2.57 vs. OR 1.32, 95% CI 1.11-1.56, Pinteraction = 0.009]. Sex also modified the relationship between DM and left ventricular geometry (Pinteraction = 0.003), whereby DM was associated with a more concentric left ventricular geometry in women than men. Women had lower quality of life than men (P < 0.001), in both DM and non-DM groups. DM was associated with worse composite outcomes at 1 year in women vs. men [hazard ratio (HR) 1.79, 95% CI 1.24-2.60 vs. HR 1.32, 95% CI 1.12-1.56; Pinteraction = 0.005). CONCLUSIONS: Asian women with HFrEF were more likely to have DM despite a lean body mass index, a greater burden of chronic kidney disease and more concentric left ventricular geometry, compared to men. Furthermore, DM confers worse quality of life, irrespective of sex, and a greater risk of adverse outcomes in women than men. These data underscore the need for sex-specific approaches to diabetes in patients with HF.
AIMS: To examine sex differences in clinical characteristics, echocardiographic features, quality of life and 1-year death or heart failure (HF) hospitalization outcomes in patients with/without diabetes mellitus (DM). METHODS AND RESULTS: Utilizing the Asian Sudden Cardiac Death in HF (ASIAN-HF) registry, 5255 patients (mean age 59.6 ± 13.1, 78% men) with symptomatic HF with reduced ejection fraction (HFrEF) were stratified by DM status to address the research aims. Despite similar prevalence of DM between Asian men (43%) and women (42%), the odds of DM increased at lower body mass index in women vs. men (≥ 23 vs. ≥ 27.5 kg/m2 , Pinteraction = 0.014). DM was more strongly related to chronic kidney disease in women vs. men [adjusted odds ratio (OR) 1.85, 95% confidence interval (CI) 1.33-2.57 vs. OR 1.32, 95% CI 1.11-1.56, Pinteraction = 0.009]. Sex also modified the relationship between DM and left ventricular geometry (Pinteraction = 0.003), whereby DM was associated with a more concentric left ventricular geometry in women than men. Women had lower quality of life than men (P < 0.001), in both DM and non-DM groups. DM was associated with worse composite outcomes at 1 year in women vs. men [hazard ratio (HR) 1.79, 95% CI 1.24-2.60 vs. HR 1.32, 95% CI 1.12-1.56; Pinteraction = 0.005). CONCLUSIONS: Asian women with HFrEF were more likely to have DM despite a lean body mass index, a greater burden of chronic kidney disease and more concentric left ventricular geometry, compared to men. Furthermore, DM confers worse quality of life, irrespective of sex, and a greater risk of adverse outcomes in women than men. These data underscore the need for sex-specific approaches to diabetes in patients with HF.
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Authors: Alice M Jackson; Rasmus Rørth; Jiankang Liu; Søren Lund Kristensen; Inder S Anand; Brian L Claggett; John G F Cleland; Vijay K Chopra; Akshay S Desai; Junbo Ge; Jianjian Gong; Carolyn S P Lam; Martin P Lefkowitz; Aldo P Maggioni; Felipe Martinez; Milton Packer; Marc A Pfeffer; Burkert Pieske; Margaret M Redfield; Adel R Rizkala; Jean L Rouleau; Petar M Seferović; Jasper Tromp; Dirk J Van Veldhuisen; Mehmet B Yilmaz; Faiez Zannad; Michael R Zile; Lars Køber; Mark C Petrie; Pardeep S Jhund; Scott D Solomon; John J V McMurray Journal: Eur J Heart Fail Date: 2022-01-04 Impact factor: 17.349