Patricia Palau1, Vicente Bertomeu-González2, Juan Sanchis3, Meritxell Soler4, Rafael de la Espriella4, Eloy Domínguez1, Enrique Santas4, Eduardo Núñez4, Francisco Javier Chorro5, Gema Miñana4, Antoni Bayés-Genís6, Julio Núñez3. 1. Servicio de Cardiología, Hospital General de Castellón, Castellón, Spain; Unitat Predepartamental de Medicina, Universitat Jaume I, Castellón, Spain. 2. Servicio de Cardiología, Hospital Universitario San Juan de Alicante, Sant Joan d'Alacant, Alicante, Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain. Electronic address: vbertog@gmail.com. 3. Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Valencia, Spain; Departamento de Medicin a, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain. 4. Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Valencia, Spain. 5. Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Valencia, Spain; Departamento de Medicin a, Universitat de València, Valencia, Spain. 6. Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
Abstract
INTRODUCTION AND OBJECTIVES: Type 2 diabetes mellitus (DM2) is a common comorbidity in patients with heart failure (HF) with preserved ejection fraction (HFpEF). Previous studies have shown that diabetic women are at higher risk of developing HF than men. However, the long-term prognosis of diabetic HFpEF patients by sex has not been extensively explored. In this study, we aimed to evaluate the differential impact of DM2 on all-cause mortality in men vs women with HFpEF after admission for acute HF. METHODS: We prospectively included 1019 consecutive HFpEF patients discharged after admission for acute HF in a single tertiary referral hospital. Multivariate Cox regression analysis was used to evaluate the interaction between sex and DM2 regarding the risk of long-term all-cause mortality. Risk estimates were calculated as hazard ratios (HR). RESULTS: The mean age of the cohort was 75.6±9.5 years and 609 (59.8%) were women. The proportion of DM2 was similar between sexes (45.1% vs 49.1, P=.211). At a median (interquartile range) follow-up of 3.6 (1-4-6.8) years, 646 (63.4%) patients died. After adjustment for risk factors, comorbidities, biomarkers, echo parameters and treatment at discharge, multivariate analysis showed a differential prognostic effect of DM2 (P value for interaction=.007). DM2 was associated with a higher risk of all-cause mortality in women (HR, 1.77; 95%CI, 1.41-2.21; P <.001) but not in men (HR, 1.23; 95%CI, 0.94-1.61; P=.127). CONCLUSIONS: After an episode of acute HF in HFpEF patients, DM2 confers a higher risk of mortality in women. Further studies evaluating the impact of DM2 in women with HFpEF are warranted.
INTRODUCTION AND OBJECTIVES:Type 2 diabetes mellitus (DM2) is a common comorbidity in patients with heart failure (HF) with preserved ejection fraction (HFpEF). Previous studies have shown that diabeticwomen are at higher risk of developing HF than men. However, the long-term prognosis of diabetic HFpEFpatients by sex has not been extensively explored. In this study, we aimed to evaluate the differential impact of DM2 on all-cause mortality in men vs women with HFpEF after admission for acute HF. METHODS: We prospectively included 1019 consecutive HFpEF patients discharged after admission for acute HF in a single tertiary referral hospital. Multivariate Cox regression analysis was used to evaluate the interaction between sex and DM2 regarding the risk of long-term all-cause mortality. Risk estimates were calculated as hazard ratios (HR). RESULTS: The mean age of the cohort was 75.6±9.5 years and 609 (59.8%) were women. The proportion of DM2 was similar between sexes (45.1% vs 49.1, P=.211). At a median (interquartile range) follow-up of 3.6 (1-4-6.8) years, 646 (63.4%) patients died. After adjustment for risk factors, comorbidities, biomarkers, echo parameters and treatment at discharge, multivariate analysis showed a differential prognostic effect of DM2 (P value for interaction=.007). DM2 was associated with a higher risk of all-cause mortality in women (HR, 1.77; 95%CI, 1.41-2.21; P <.001) but not in men (HR, 1.23; 95%CI, 0.94-1.61; P=.127). CONCLUSIONS: After an episode of acute HF in HFpEF patients, DM2 confers a higher risk of mortality in women. Further studies evaluating the impact of DM2 in women with HFpEF are warranted.
Keywords:
Diabetes mellitus; Diferencias entre sexos; Heart failure with preserved ejection fraction; Insuficiencia cardiaca con fracción de eyección preservada; Mortalidad; Mortality; Mujeres; Sex differences; Women
Authors: Enrique Santas; Patricia Palau; Pau Llácer; Rafael de la Espriella; Gema Miñana; Gonzalo Núñez-Marín; Miguel Lorenzo; Raquel Heredia; Juan Sanchis; Francisco Javier Chorro; Antoni Bayés-Genís; Julio Núñez Journal: J Am Heart Assoc Date: 2021-12-20 Impact factor: 6.106
Authors: Vicente Bertomeu-Gonzalez; Lorenzo Fácila; Patricia Palau; Gema Miñana; Gonzalo Núñez; Rafael de la Espriella; Enrique Santas; Eduardo Núñez; Vicent Bodí; Francisco Javier Chorro; Alberto Cordero; Juan Sanchis; Josep Lupón; Antoni Bayés-Genís; Julio Núñez Journal: ESC Heart Fail Date: 2020-08-13