Physicians' Academy for Cardiovascular Education

Diabetes and microvascular complications predict outcomes in HFpEF

The Prognostic Significance of Diabetes and Microvascular Complications in Patients With Heart Failure With Preserved Ejection Fraction

Literature - Sandesara PB, O’Neal WT, Kelli HM, et al. - Diabetes Care 2017; published online ahead of print


Almost half of patients with heart failure with preserved ejection fraction (HFpEF) also have diabetes mellitus (DM), which is associated with nearly a twofold increase in morbidity and mortality in these patients [1-3]. Diabetes is, however, not a uniform disorder, and the risk of adverse CV outcomes may vary with disease severity (e.g., presence of microvascular complications).

In this analysis of the TOPCAT study [4], the prognostic significance of DM and its microvascular complications was evaluated in 3,385 patients with symptomatic HF and an EF ≥45%. The microvascular complications included neuropathy, nephropathy, and retinopathy, and the study outcome was the composite of CV mortality, aborted cardiac arrest, or HF hospitalization

Main results


In the TOPCAT study, diabetes and its microvascular complications carried important prognostic information regarding adverse outcomes in HFpEF patients. In addition, the microvascular disease burden predicts HF re-hospitalization in this high-risk group. These findings show that additional preventive strategies to reduce morbidity and mortality in HFpEF patients with DM are needed.


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