Left ventricular dysfunction and outcome at two-year follow-up in patients with type 2 diabetes: The DYDA study
Introduction
The risk to develop heart failure (HF) is high in patients with type 2 diabetes mellitus (DM) independently of the coexistence of ischemic heart disease, and their prognosis, once HF happens, is poorer than that of patients without DM [1], [2], [3], [4], [5]. In patients with DM, left ventricular (LV) performance insidiously progresses from a normal state to asymptomatic systolic and/or diastolic dysfunction (LVD) which may herald, in some case, overt HF [6], [7], [8], [9], [10]. We recently published the results of baseline echocardiographic examination performed in a large cohort of patients with DM without overt cardiac disease (DYDA study) [11], [12]. The analyses of our data showed an unexpectedly high prevalence of LVD in these asymptomatic subjects who were successively followed-up for 2 years. In the present study, we analyze data on the echocardiographic re-evaluation and clinical events to assess:
- 1.
The presence and predictors of systolic and/or diastolic LVD detected at baseline or at 2-year follow-up;
- 2.
The incidence and predictors of a combined outcome measure of all-cause death and hospitalizations at 2-year follow-up.
Section snippets
Design and methods
Study population. DYDA was a prospective, multicenter, nationwide study, promoted by the Italian Association of Hospital Cardiologists (ANMCO) and the Italian Association of Clinical Diabetologists (AMD), evaluating clinical and echocardiographic characteristics of a large cohort of individuals with DM. Inclusion and exclusion criteria were previously reported [11], [12]. Participants were recruited from July 24, 2006 to March 31, 2008 in 37 Italian diabetes referral centers and underwent a
Results
Patients’ disposition during the study is summarized in Fig. 1. A total of 970 subjects were enrolled in the DYDA study. Ten patients were excluded from the analyses due to protocol violations, leaving a study population of 960 patients. Three patients were lost to follow-up, so two-year survival and hospitalizations’ data were available in 957 patients. Baseline characteristics of the study population are reported in Table 1. Of note, more than one third of patients were obese, systolic blood
Discussion
DM is a strong predictor of incident HF, independent of both coexisting myocardial infarction and other cardiovascular risk factors [1]. Recently, it has been established that DM increases hazard of HF by 66% [20]. The results of the present study show that in asymptomatic patients with DM, systolic and/or diastolic LVD may frequently be detected at baseline evaluation and/or develop subsequently in a relatively short time. In our experience, any LVD was detected during the study in about 90%
Funding
The study was partially supported by an unrestricted grant from Sanofi-Aventis.
Analytical work was partly supported by Ministero della Salute, project RF-FCG-2006-379933.
Conflict of interest
The authors declare that they have no conflict of interest.
Acknowledgments
We thank Renato Urso, MSc for statistical advice.
References (35)
- et al.
Survival and hospitalization in heart failure patients with or without diabetes treated with beta-blockers
J Card Fail
(2003) - et al.
Echocardiographic detection of early diabetic myocardial disease
J Am Coll Cardiol
(2003) - et al.
Prevalence and prognosis of left ventricular systolic dysfunction in asymptomatic diabetic patients without known coronary artery disease referred for stress single-photon emission computed tomography and assessment of left ventricular function
Am Heart J
(2007) Diastolic dysfunction and diabetic cardiomyopathy: evaluation by Doppler echocardiography
J Am Coll Cardiol
(2006)- et al.
The development of heart failure in patients with diabetes mellitus and pre-clinical diastolic dysfunction a population-based study
J Am Coll Cardiol
(2010) Pre-clinical diastolic dysfunction in diabetic patients: where do we go from here?
J Am Coll Cardiol
(2010)- et al.
Gender differences in left ventricular systolic function in American Indians (from the Strong Heart Study)
Am J Cardiol
(2006) - et al.
Change in high-density lipoprotein cholesterol and risk of subsequent hospitalization for coronary artery disease or stroke among patients with type 2 diabetes mellitus
Am J Cardiol
(2011) - et al.
Diabetes and incident heart failure in hypertensive and normotensive participants of the Strong Heart Study
J Hypertens
(2010) - et al.
Type 2 diabetes mellitus and risk of coronary heart disease: results of the 10-year follow-up of the PROCAM study
Eur J Cardiovasc Prev Rehabil
(2007)
High prevalence of previously unknown heart failure and left ventricular dysfunction in patients with type 2 diabetes
Diabetologia
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC
Eur Heart J
Analysis of midwall shortening reveals high prevalence of left ventricular myocardial dysfunction in patients with diabetes mellitus: the DYDA study
Eur J Prev Cardiol
Predictors of early-stage left ventricular dysfunction in type 2 diabetes: results of DYDA study
Eur J Cardiovasc Prev Rehabil
Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings
Circulation
Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms
J Am Soc Echocardiogr
Assessment of left ventricular ejection fraction and volumes by real-time, two-dimensional echocardiography. A comparison of cineangiographic and radionuclide techniques
Circulation
Cited by (14)
Sex- and gender-differences in chronic long-term complications of type 1 and type 2 diabetes mellitus in Italy
2022, Nutrition, Metabolism and Cardiovascular DiseasesCitation Excerpt :This study found a high prevalence of early LV dysfunction, with age, worse HbA1c, traits of insulin resistance, treatment with metformin or doxazosin that were associated with a greater risk [36]. At the two-year follow-up of the same study, any LV dysfunction was very frequent in T2DM patients without overt CVD, and all-cause death or hospitalization occurred in 15% of these subjects [37]. Notably, in the DYDA trial, no sex differences were reported for ventricular dysfunction or HF.
2018 consensus of the Taiwan Society of Cardiology and the Diabetes Association of Republic of China (Taiwan) on the pharmacological management of patients with type 2 diabetes and cardiovascular diseases
2018, Journal of the Chinese Medical AssociationCitation Excerpt :In the Left Ventricular Dysfunction in Diabetes (DYDA) study, 960 patients with type 2 diabetes but without overt heart disease were followed up for 2 years to examine the LV dysfunction and CV outcomes.171 The use of repaglinide was associated with a 2-fold risk of all-cause death or hospitalization (OR 2.00, 95% CI 1.17–3.44, p = 0.01).171 In a retrospective cohort study using the Taiwan NHIRD, the use of glinides was associated with a higher risk of HF admission compared with acarbose (adjusted HR 1.53, 95% CI 1.24–1.88).172
Potential Drug Combinations to Reduce Cardiovascular Disease Burden in Diabetes
2016, Trends in Pharmacological SciencesCitation Excerpt :A meta-analysis of 72 randomized controlled trials involving sulfonylurea monotherapy for 24 weeks or more in patients with T2DM found that all-cause mortality, cardiovascular mortality, and a composite of MI, stroke, and cardiovascular mortality were increased in patients treated with glibenclamide, glipizide, and tolbutamide [61]. In the Left Ventricular Dysfunction in Type 2 Diabetes Mellitus (DYDA) study, repaglinide therapy was found to be an independent predictor of left ventricular dysfunction [62]. In summary, although all secretagogs may not have similar adverse effects, it is unclear whether any of them have significant protective effects.
Serum 25-hydroxyvitamin D is associated with major cardiovascular risk factors and cardiac structure and function in patients with coronary artery disease
2015, Nutrition, Metabolism and Cardiovascular DiseasesCitation Excerpt :The low Vitamin D levels commonly observed among Type 2 diabetics [9] may be among the factors explaining their increased risk for cardiovascular disease (CVD) [9,10]. Diastolic dysfunction has been reported to be common among diabetic patients [11], and diabetic subjects have higher left ventricular mass index, higher left atrium volume and lower ejection fraction [12] than non-diabetics. The role of Vitamin D in explaining these differences is not known.
Oral glucose-lowering drugs and cardiovascular risk
2018, Revista Colombiana de CardiologiaTable 3: Cardiovascular effects of anti-diabetic drugs
2020, Revista de la Sociedad Argentina de Diabetes