Risk factors for heart failure in patients with type 2 diabetes mellitus

Abstract

Abstract. Heart failure (HF) remains a global health problem, affecting 64 million people worldwide, with prevalence sharply increasing after the age of 60, reaching 11.8%, according to the World Heart Federation (2023). In patients with type 2 diabetes mellitus (T2DM), HF most commonly presents as HF with preserved ejection fraction (HFpEF), driven by diastolic dysfunction of the myocardium in the setting of diabetic cardiomyopathy and arterial hypertension. However, the impact of various risk factors for HF development in patients with T2DM under current treatment strategies remains insufficiently studied.

Objective. To assess the impact of disease duration, the degree of glycemic control (HbA1c level), and the presence of micro-/macrovascular complications as risk factors for HF in patients with T2DM.

Materials and Methods. The study was conducted at the Department of Cardiometabolic Diseases, State Institution “Scientific and Practical Medical Center of Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine”. A total of 36 patients with T2DM and HF of different phenotypes were examined. All patients underwent standard laboratory and instrumental diagnostic methods during hospitalization. Diastolic dysfunction of the left ventricle was diagnosed in all cases, confirmed both by clinical symptoms of HF (dyspnea, reduced exercise tolerance, edema, etc.) and echocardiographic findings. Further distribution was carried out based on left ventricular ejection fraction (LVEF), which allowed classification into three HF phenotype groups: group 1 – 11 patients (30.5%) with reduced EF (HFrEF); group 2 – 11 patients (30.5%) with mildly reduced EF (HFmrEF); and group 3 – 14 patients (38.9%) with preserved EF (HFpEF).

Results. In T2DM patients, longer diabetes duration was associated with a reduction in LVEF (r = -0.32, p = 0.049): every additional 10 years of disease duration corresponded to a mean 3.2% decrease in LVEF. Higher HbA1c levels also showed a negative trend in relation to LVEF (r = -0.29, p = 0.09) and significantly increased the risk of myocardial infarction (MI) 2.3-fold when HbA1c exceeded 7%. Each additional 5 years of diabetes duration increased the risk of MI 1.8-fold. Moreover, both longer diabetes duration (r = -0.48, p = 0.003) and higher HbA1c (r = -0.41, p = 0.012) were associated with lower estimated glomerular filtration rate (eGFR), underscoring the role of glycemic control in preventing both cardiac and renal complications.

Conclusions. Longer T2DM duration and poor glycemic control are associated with impaired cardiac and renal function, indicating that optimization of blood glucose levels may help reduce the risk of these complications.