Risk of incident heart failure in individuals with early-onset type 2 diabetes.

Abstract

CONTEXT\nEarly-onset diabetes has been associated with unfavourable cardiovascular risk but data on heart failure (HF) in this subpopulation are scarce.\n\n\nOBJECTIVE\nTo study the risk of, and risk factors for incident HF in individuals with early- onset type 2 diabetes.\n\n\nDESIGN, PARTICIPANT AND SETTING\n606 individuals with type 2 diabetes diagnosed before 40 years old (early-onset) and 1258 counterparts with diabetes diagnosed between 41 to 65 years old (usual-onset) with no HF history were followed for a median of 7.1 years in a regional hospital.\n\n\nMAIN OUTCOME MEASURE\nIncident HF by European Cardiology Society criteria.\n\n\nRESULTS\n62 and 108 HF events were identified in early- and usual- onset group (1.55 and 1.29 per 100 patient- years), respectively. As compared to usual-onset counterparts, individuals with early-onset diabetes had 1.20 (95% CI 0.88-1.63, P=0.26) folds unadjusted and 1.91 (95% CI 1.37-2.66, P<0.001) folds age- adjusted hazards for incident HF. Adjustment for traditional cardio-metabolic risk factors only moderately mitigated the hazards (adjusted HR 1.69, 95% CI 1.19-2.40, P=0.003). However, additional adjustment for eGFR and albuminuria markedly attenuated the association of early-onset age with incident HF (adjusted HR 1.24, 95% CI 0.87-1.77, P=0.24). Noteworthy, a long diabetes duration was not significantly associated with HF risk after accounting for kidney measures.\n\n\nCONCLUSION\nIndividuals with early- onset diabetes have at least the same absolute risk and 2-fold age- adjusted relative risk for incident HF. Excess cardio-renal risk factors but not a long diabetes duration are main drivers for HF development in this diabetic population.