Impact of diabetes and sex in heart failure with reduced ejection fraction patients from the ASIAN-HF registry

C. Chandramouli, T.-H.K. Teng, Wan Ting Tay, M.R. MacDonald, J. Tromp, B.B. Siswanto, E.B. Reyes, T. Ngarmukos, C.-L. Hung, I. Anand, J.G. Regensteiner, H.B. Liew, A. Mark Richards, Carolyn Lam

Research output: Contribution to journalArticlepeer-review

32 Citations (Scopus)

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.
Original languageEnglish
Pages (from-to)297-307
Number of pages11
JournalEuropean Journal of Heart Failure
Volume21
Issue number3
DOIs
Publication statusPublished - 1 Mar 2019

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