Incidence of atrial fibrillation, ischaemic heart disease and heart failure in patients with diabetes

Abstract Background Diabetes has strongly been linked to atrial fibrillation, ischaemic heart disease and heart failure. The epidemiology of these cardiovascular diseases is changing, however, due to changes in prevalence of obesity-related conditions and preventive measures. Recent population studies on incidence of atrial fibrillation, ischaemic heart disease and heart failure in patients with diabetes are needed. Methods A dynamic longitudinal cohort study was performed using primary care databases of the Julius General Practitioners’ Network. Diabetes status was determined at baseline (1 January 2014 or upon entering the cohort) and participants were followed-up for atrial fibrillation, ischaemic heart disease and heart failure until 1 February 2019. Age and sex-specific incidence and incidence rate ratios were calculated. Results Mean follow-up was 4.2 years, 12,168 patients were included in the diabetes group, and 130,143 individuals in the background group. Incidence rate ratios, adjusted for age and sex, were 1.17 (95% confidence interval 1.06–1.30) for atrial fibrillation, 1.66 (1.55–1.83) for ischaemic heart disease, and 2.36 (2.10–2.64) for heart failure. Overall, incidence rate ratios were highest in the younger age categories, converging thereafter. Conclusion There is a clear association between diabetes and incidence of the major chronic progressive heart diseases, notably with heart failure with a more than twice increased risk.

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Role of obesity and hypertension in the incidence of atrial fibrillation, ischaemic heart disease and heart failure in patients with diabetes

Cardiovascular Diabetology ◽

10.1186/s12933-021-01331-5 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Lucia La Sala ◽

Antonio E. Pontiroli

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Primary Care ◽

Body Mass Index ◽

Heart Disease ◽

Ischaemic Heart Disease ◽

Heart Diseases ◽

Treatment Of Hypertension ◽

Patients With Diabetes

AbstractIn a cohort study performed using primary care databases in a General Practitioners Network, Groenewegen et al. report a clear association between diabetes and incidence of the major chronic progressive heart diseases, notably heart failure (Groenewegen et al. in Cardiovasc Diabetol 20:123, 2021). However, no mention is made of body mass index and hypertension in the methods or in the results. Obesity is linked to hypertension and hypertension is a major risk factor for all cardiovascular diseases, and prospective studies have shown that obesity and hypertension contribute significantly to atrial fibrillation in persons with diabetes. The data would be improved by assessing the role of obesity and of hypertension in the incidence of heart diseases in these patients. This would also lead to a better and personalized treatment of patients with diabetes, for instance through weight loss and intensification of treatment of hypertension, to modify the incidence of atrial fibrillation, ischaemic heart disease and heart failure.

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Atrial fibrillation in heart failure is associated with an increased risk of death only in patients with ischaemic heart disease

European Journal of Heart Failure ◽

10.1093/eurjhf/hfq052 ◽

2010 ◽

Vol 12 (7) ◽

pp. 692-697 ◽

Cited By ~ 16

Author(s):

Jakob Raunsø ◽

Ole Dyg Pedersen ◽

Helena Dominguez ◽

Morten Lock Hansen ◽

Jacob Eifer Møller ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Disease ◽

Ischaemic Heart Disease ◽

Risk Of Death ◽

Increased Risk

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Electronic Record Linkage cohort study of evidence-based management and outcomes in patients with ischaemic heart disease and atrial fibrillation

10.23889/suthesis.58169 ◽

2021 ◽

Author(s):

◽

Edward Daniel Harris

Keyword(s):

Atrial Fibrillation ◽

Heart Disease ◽

Ischaemic Heart Disease ◽

Evidence Based Medicine ◽

Lipid Lowering ◽

Evidence Based ◽

Lipid Lowering Therapy ◽

Lipid Levels ◽

Increased Risk ◽

Based Medicine

BACKGROUND Implementation of evidence-based medicine is often suboptimal. The objectives of this thesis are to explore the delivery of evidence-based medicine and outcomes in patients with ischaemic heart disease (IHD) and atrial fibrillation (AF). METHODS Retrospective observational cohort studies were conducted using linked anonymised data from the secure anonymised information linkage (SAIL) databank. Patients included (i) those undergoing percutaneous coronary intervention, (ii) patients prescribed vitamin K antagonist (VKA) for AF, and (iii) patients with AF who had undergone successful PCI. RESULTS Amongst patients directed to take clopidogrel for one-year post-PCI, discontinuation was far lower (~6%) than in previous studies where the treatment duration was not known. Despite this, early discontinuation and/or bleeding was associated with an increased risk of adverse events. In a national cohort of PCI patients, we observed a low rate of achievement of international guideline target lipid levels (<25%) and low prescribing of intensive lipid lowering therapy amongst those not at target. Females and patients who had undergone elective PCI were least likely to have their lipid levels documented and be at target. In patients prescribed VKA for AF guideline defined poor anticoagulation control was common and associated with significantly higher bleeding event rates, independent of common comorbidities that are recognised as risk factors for stroke and bleeding. In patients with AF who had undergone PCI outcomes were poor: approximately 1 in 5 had either a stroke, acute coronary syndrome (ACS) or died in the year follow-up. Bleeding events were also common and associated with a five, three and four-fold increased risk of stroke, ACS, and death. CONCLUSION This thesis has characterised the nature of multiple therapeutic gaps and associated adverse outcomes with common clinical conditions. Thus, identifying opportunities to improve outcomes in individual patients and at population level.

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Pronounced Risk of Fractures among Elderly Men Affected by Granulomatosis with Polyangiitis

The Journal of Rheumatology ◽

10.3899/jrheum.141566 ◽

2015 ◽

Vol 42 (9) ◽

pp. 1667-1671 ◽

Cited By ~ 1

Author(s):

Mikkel Faurschou ◽

Bo Baslund ◽

Niels Obel

Keyword(s):

Fracture Risk ◽

Incidence Rate ◽

Granulomatosis With Polyangiitis ◽

Care Center ◽

Tertiary Care ◽

Elderly Male ◽

Increased Risk ◽

Rate Ratios ◽

Population Controls ◽

Age And Sex

Objective.It is unknown whether patients affected by granulomatosis with polyangiitis (GPA) are at increased risk of fractures, and whether the fracture risk in GPA varies with age and sex. The aim of the present study was to compare the fracture risk among patients with GPA with that among age- and sex-matched population controls.Methods.We established a monocentric cohort of patients treated for GPA at a Danish tertiary care center from 1995 to 2010 (n = 159) and a register-derived GPA cohort identified from the Danish National Hospital Register (n = 402). Each patient was matched with 7 population controls. The occurrence of fractures among patients was compared with that among controls by calculation of incidence rate ratios (IRR).Results.In the monocentric cohort, an increased fracture risk was observed among men aged ≥ 55 years at the time of first hospitalization for GPA (IRR 3.5, 95% CI 1.6–7.6), but not among men < 55 years (IRR 0.3, 95% CI 0.04–2.1) or women (IRR women ≥ 55 yrs: 1.0, 95% CI 0.4–2.7 and IRR for women < 55 yrs: 0.7, 95% CI 0.2–2.4). In the register-derived cohort, an increased fracture risk was also observed among men aged ≥ 55 years at study baseline (IRR 2.0, 95% CI 1.2–3.5), whereas the incidence rate of fractures was not significantly increased among younger men or women (IRR for men < 55 yrs: 1.0, 95% CI 0.4–2.3; IRR for women ≥ 55 yrs: 0.9, 95% CI 0.5–1.5; IRR for women < 55 yrs: 1.6, 95% CI 0.7–3.6).Conclusion.Elderly male patients with GPA have a pronounced risk of developing fractures. This finding is of relevance for the clinical management of patients with GPA.

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Anti-inflammatory therapy in ischaemic heart disease: from canakinumab to colchicine

European Heart Journal Supplements ◽

10.1093/eurheartj/suab084 ◽

2021 ◽

Vol 23 (Supplement_E) ◽

pp. E13-E18

Author(s):

Felicita Andreotti ◽

Aldo Pietro Maggioni ◽

Alice Campeggi ◽

Adelaide Iervolino ◽

Giovanni Scambia ◽

...

Keyword(s):

Heart Disease ◽

Ischaemic Heart Disease ◽

Cardiovascular Prevention ◽

Clinical Results ◽

Reactive Protein ◽

Major Cardiovascular Events ◽

Increased Risk ◽

Patients With Diabetes ◽

Coronary Syndromes ◽

Anti Inflammatory

Abstract Four large trials have recently evaluated the effects of anti-inflammatory drugs in the secondary prevention of major cardiovascular events (MACE) in over 25 000 patients followed for 1.9–3.7 years. CANTOS tested subcutaneous canakinumab [an anti-interleukin (IL) 1β antibody] 300 mg every 3 months against placebo in patients with a history of myocardial infarction (MI) and serum C-reactive protein (CRP) >2 mg/L, demonstrating efficacy in preventing MACE but increased rates of fatal infections. COLCOT (in patients with recent MI) and LoDoCo2 (in patients with chronic coronary syndromes) tested oral colchicine (an NLRP3 inflammasome inhibitor) 0.5 mg daily vs. placebo, demonstrating prevention of MACE with a slightly increased risk of pneumonia in COLCOT (0.9 vs. 0.4%) but not in LoDoCo2. CIRT tested oral methotrexate (an anti-rheumatic anti-nuclear factor-kB) 15–20 mg per week against placebo in ischaemic heart disease patients with diabetes or metabolic syndrome, without significant reduction in MACE rates or in circulating IL6 or CRP levels, and with increased risk of skin cancers. In summary, canakinumab and colchicine have shown efficacy in preventing MACE in ischaemic heart disease patients, but only colchicine has acceptable safety (and cost) for use in secondary cardiovascular prevention. Clinical results are expected with the anti-IL6 ziltivekimab.

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Proteomic mechanistic profile of patients with diabetes at risk of developing heart failure: insights from the HOMAGE trial

Cardiovascular Diabetology ◽

10.1186/s12933-021-01357-9 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Job A. J. Verdonschot ◽

João Pedro Ferreira ◽

Pierpaolo Pellicori ◽

Hans-Peter Brunner-La Rocca ◽

Andrew L. Clark ◽

...

Keyword(s):

Heart Failure ◽

At Risk ◽

Plasma Concentrations ◽

Diabetic Patients ◽

Proteomic Profile ◽

Developing Heart ◽

Diabetes Status ◽

Increased Risk ◽

Patients With Diabetes ◽

Patients At Risk

Abstract Background Patients with diabetes mellitus (DM) are at increased risk of developing heart failure (HF). The “Heart OMics in AGEing” (HOMAGE) trial suggested that spironolactone had beneficial effect on fibrosis and cardiac remodelling in an at risk population, potentially slowing the progression towards HF. We compared the proteomic profile of patients with and without diabetes among patients at risk for HF in the HOMAGE trial. Methods Protein biomarkers (n = 276) from the Olink®Proseek-Multiplex cardiovascular and inflammation panels were measured in plasma collected at baseline and 9 months (or last visit) from HOMAGE trial participants including 217 patients with, and 310 without, diabetes. Results Twenty-one biomarkers were increased and five decreased in patients with diabetes compared to non-diabetics at baseline. The markers clustered mainly within inflammatory and proteolytic pathways, with granulin as the key-hub, as revealed by knowledge-induced network and subsequent gene enrichment analysis. Treatment with spironolactone in diabetic patients did not lead to large changes in biomarkers. The effects of spironolactone on NTproBNP, fibrosis biomarkers and echocardiographic measures of diastolic function were similar in patients with and without diabetes (all interaction analyses p > 0.05). Conclusions Amongst patients at risk for HF, those with diabetes have higher plasma concentrations of proteins involved in inflammation and proteolysis. Diabetes does not influence the effects of spironolactone on the proteomic profile, and spironolactone produced anti-fibrotic, anti-remodelling, blood pressure and natriuretic peptide lowering effects regardless of diabetes status. Trial registration NCT02556450.

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P3773Thromboembolic risk of heart failure with preserved, mid-range, and reduced ejection fraction in atrial fibrillation: results from the CODE-AF registry

European Heart Journal ◽

10.1093/eurheartj/ehz745.0623 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Chung ◽

T H Kim ◽

J S Uhm ◽

M J Cha ◽

J M Lee ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ejection Fraction ◽

Incidence Rate ◽

Risk Score ◽

Thromboembolic Event ◽

Clinical Variable ◽

Thromboembolic Risk ◽

Reduced Ejection Fraction ◽

Increased Risk

Abstract Purpose Thromboembolic risk of atrial fibrillation (AF) in heart failure with preserved (HFpEF), mid-range (HFmrEF), and reduced ejection fraction (HFrEF) is not well identified. This study assessed the thromboembolic risk of AF in patients with HFpEF, HFmrEF and HFrEF. Materials and methods Within the CODE-AF prospective, outpatient registry (COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation), a total of 10476 patients with non-valvular AF including 929 (8.8%) patients with HF was analyzed. Multivariable cox regression was used to evaluate the risk of thromboembolic event, including stroke, systemic embolism and transient ischemic attack. Hazard ratio (HR) was adjusted by each component of CHA2DS2-VASc risk score and the use of oral anticoagulant (OAC). Results The median age of the overall population was 68.0 (interquartile range, 60.0–75.0); 63.9% were male. The proportion of HFpEF, HFmrEF and HFrEF was 43.6%, 26.7% and 29.7%, respectively. CHA2DS2-VASc risk score was higher in HF group than no-HF group. OAC was more commonly used in HF group than no-HF group (85.2% vs. 68.9%, p<0.001). The rate of OAC usage was 85.1%, 86.6%, and 84.0% in HFpEF, HFmrEF, and HFrEF group, respectively. During follow-up period of median 14.3 months, 15 patients experienced thromboembolic event in HF group with incidence rate of 1.39 events per 100 person-years, while 94 patients did in no-HF group with 0.87 events per 100 person-years. In patients without OAC, incidence rate of thromboembolic event was 1.31, 2.77, and 6.24 events per 100 person-years in HFpEF, HFmrEF, and HFrEF, respectively. Compared with no-HF group, HF was associated with increased risk of thromboembolic event with clinical variable adjusted HR of 3.04 (95% CI, 1.12–8.26, p=0.03). Among 3 types of HF, HFrEF increased the risk of thromboembolic event (adjusted HR 7.39, 95% CI 2.15–25.44, P=0.002), while HFmrEF or HFpEF did not. Finally, in patients with optimal OAC, risk of thromboembolic event was not increased by HF or HFrEF. Conclusion In OAC-naïve non-valvular AF, HF was associated with increased risk of thromboembolic event. Among 3 types of HF, HFrEF increased the risk of thromboembolic event, while HFmrEF or HFpEF did not. However, in patients with optimal OAC, even HFrEF was not associated with increased risk of thromboembolic event. These results support current OAC strategy in HF patients, especially emphasizing optimal OAC in HFrEF population. Acknowledgement/Funding The National Research Foundation of Korea

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Heart failure in low risk patients with atrial fibrillation, nationwide registry case-control study based on 227811 patients

European Heart Journal ◽

10.1093/eurheartj/ehab724.0843 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

C Basic ◽

P Hansson ◽

T Zverkova-Sandstrom ◽

B Johansson ◽

M Fu ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Disease ◽

Cardiovascular Risk ◽

Incidence Rate ◽

Prediction Models ◽

Risk Profile ◽

Cardiovascular Risk Profile ◽

One Year ◽

Low Cardiovascular Risk

Abstract Background Heart failure (HF) is common in patients with atrial fibrillation (AF), and also associated with worse outcome. Consequently, it is commonly included in risk prediction models for AF, used in daily clinical praxis. However, knowledge about the association between solely AF and incidental HF is limited. Aim This study aims to evaluate the short and long-term risks for onset of HF in patients with AF and low cardiovascular risk profile. Methods All patients with first recorded hospitalization for AF in the Swedish National Patient Register, were included from the 1St January 1987 to 31st December 2018. Each patient with AF was matched by age, sex and county with two controls from the Swedish Total Population Register. Patients <18 years, or with concomitant hypertension, diabetes mellitus, coronary and periphery artery disease, previous stroke or transitory ischemic attack, cardiomyopathy, pulmonary arterial hypertension, congenital heart disease, valvular heart disease and renal failure prior or at baseline were excluded. Results In total 227 811 patients and 452 712 controls met the inclusion and exclusion criteria and were included in the study. The incidence rate for incidental HF per 1000 person-year within one year after AF diagnosis was 6.2 (95% CI: 4.5–8.6) among patient 18–34, increased with increasing age and was 142.8 (95% CI: 139.4–146.3) among those >80 years. Within five years the incidence rate decreased in all age categories and was 2.4 (95% CI: 1.8–3.0) among the youngest and 94.0 (95% CI: 92.4–95.6) in the oldest age group. When compared to matched controls from the general population patients with AF had a hazard ratio (HR) and CI 95% to develop HF within one year at 103.9 (46.3–233.1), 34.9 (26.5–45.9), 17.5 (15.5–19.8), 10.3 (9.6–11.1) and 6.1 (5.8–6.4) among patients aged 18–34, 35–49, 50–59, 60–69, 70–79 and >80 years, respectively. Conclusion Despite low cardiovascular risk profile AF still carries high risk for developing incidental HF in particular during the first observation year with increasing tendency along with increasing age. Younger patients with AF and without other cardiovascular comorbidities had more than 100 times higher relative risk to develop HF within one year when compared to matched controls. FUNDunding Acknowledgement Type of funding sources: None.

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Abstract P168: Animal & Dairy Protein Intakes Associate With Increased Risk of Heart Failure in Men: The Kuopio Ischaemic Heart Disease Risk Factor Study

Circulation ◽

10.1161/circ.135.suppl_1.p168 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Heli E Virtanen ◽

Sari Voutilainen ◽

Timo T Koskinen ◽

Jaakko Mursu ◽

Tomi-Pekka Tuomainen ◽

...

Keyword(s):

Heart Failure ◽

Heart Disease ◽

Ischaemic Heart Disease ◽

Disease Risk ◽

Increased Risk ◽

Risk Factor Study ◽

Factor Study ◽

Dairy Protein ◽

Fermented Dairy

Introduction: Different protein sources, such as processed red meat and fish have indicated distinct associations with risk of heart failure. Whether these distinct associations are partly due to the differences in proteins themselves remains unclear. Thus, we examined the associations of proteins from different food sources with risk of heart failure in Finnish male subjects. Hypothesis: We hypothesized that proteins from different dietary sources would have distinct associations with heart failure risk. Methods: The study included 2441 men aged 42-60 y at the baseline examinations in 1984-1989 in the Kuopio Ischaemic Heart Disease Risk Factor Study. Protein intakes at baseline were assessed with 4-d dietary records. Data on incident heart failure cases were obtained from national registers. The multivariable-adjusted risk of heart failure according to protein intake was estimated by Cox proportional hazard ratios. Multivariable analyses included age, examination year, education, income, family history of ischaemic heart disease, smoking, leisure-time physical activity, and intakes of alcohol, energy, fiber, and saturated, monounsaturated, polyunsaturated and trans fatty acids. Results: During the mean follow-up time of 22.2 y, 334 incident cases of heart failure occurred. Total protein (multivariable-adjusted extreme-quartile HR 1.45, 95% CI: 1.04-2.00, P-trend 0.01), animal protein (HR 1.56, 95% CI: 1.12-2.17, P-trend 0.01) and dairy protein (HR 1.53, 95% CI: 1.11-2.11, P-trend 0.01) intakes were associated with increased risk of heart failure. Especially protein from fermented dairy products associated with higher risk (HR 1.48, 95% CI: 1.08-2.02, P-trend 0.002). Adjustment for the potential effect mediators [body mass index and diseases or medications (coronary heart disease, hypertension, type 2 diabetes, lipid-lowering or heart medications) at baseline and during the follow-up] slightly attenuated the associations, but associations of animal, dairy and fermented dairy protein remained statistically significant. Plant protein intake had no association with heart failure risk (HR 1.00, 95% CI: 0.63-1.59, P-trend 0.82). Conclusions: Our data suggest that high intake of protein, especially from animal and dairy sources, may increase the risk of heart failure.

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