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

on behalf of the ASIAN-HF Investigators

doi:10.1002/ejhf.1358

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

on behalf of the ASIAN-HF Investigators

Medicine - Veteran's Administration Medical Center

Research output: Contribution to journal › Article › peer-review

32 Scopus citations

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, P_interaction = 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, P_interaction = 0.009]. Sex also modified the relationship between DM and left ventricular geometry (P_interaction = 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; P_interaction = 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 language	English (US)
Pages (from-to)	297-307
Number of pages	11
Journal	European Journal of Heart Failure
Volume	21
Issue number	3
DOIs	https://doi.org/10.1002/ejhf.1358
State	Published - Mar 2019

Bibliographical note

Funding Information:
The ASIAN-HF study ASIAN-HF is supported by grants from Boston Scientific Investigator Sponsored Research Program, National Medical Research Council of Singapore [NMRC/CSA/0052/2013], A*STAR Biomedical Research Council ATTRaCT program [SPF2014/003] and Bayer. ClinicalTrials.gov Identifier: NCT01633398. Conflict of interest: C.S.P.L: none relevant to the present work. Unrelated to the present work, C.S.P.L. is supported by a Clinician Scientist Award from the National Medical Research Council Singapore, non-financial support from Boston Scientific, non-financial support from Bayer, non-financial support from Thermofisher, non-financial support from Vifor Pharma, other from Bayer, Novartis, Takeda, Merck, Astra Zeneca, Janssen Research & Development, LLC, Menarini, Boehringer Ingelheim, Abbott Diagnostics, DC Devices, outside the submitted work. In addition, C.S.P.L. has a patent PCT/SG2016/050217 pending. A.M.R.: none relevant to the present work; is supported by a Singapore Translational Research (STaR) award from the National Medical Research Council Singapore; is a named investigator on projects supported by grants from Boston Scientific, Bayer, Astra Zeneca, Roche Diagnostics, and has received research support in kind Thermo Fisher, Roche

Keywords

Asia
Diabetes
Heart failure
Sex differences
Women

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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

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.",

keywords = "Asia, Diabetes, Heart failure, Sex differences, Women",

author = "{on behalf of the ASIAN-HF Investigators} and Chanchal Chandramouli and Teng, {Tiew Hwa Katherine} and Tay, {Wan Ting} and Jonathan Yap and MacDonald, {Michael R.} and Jasper Tromp and Limin Yan and Bambang Siswanto and Reyes, {Eugenio B.} and Tachapong Ngarmukos and Yu, {Cheuk Man} and Hung, {Chung Lieh} and Richards, {A. Mark} and Ling, {Lieng Hsi} and Regensteiner, {Judith G.} and Lam, {Carolyn S.P.} and {Mark Richards}, A. and Lam, {Carolyn S.P.} and Hung, {Chung Lieh} and Ling, {Lieng Hsi} and Liew, {Houng Bang} and Calambur Narasimhan and Tachapong Ngarmukos and Park, {Sang Weon} and Eugenio Reyes and Inder Anand and Wataru Shimizu and Inder Anand",

note = "Funding Information: The ASIAN-HF study ASIAN-HF is supported by grants from Boston Scientific Investigator Sponsored Research Program, National Medical Research Council of Singapore [NMRC/CSA/0052/2013], A*STAR Biomedical Research Council ATTRaCT program [SPF2014/003] and Bayer. ClinicalTrials.gov Identifier: NCT01633398. Conflict of interest: C.S.P.L: none relevant to the present work. Unrelated to the present work, C.S.P.L. is supported by a Clinician Scientist Award from the National Medical Research Council Singapore, non-financial support from Boston Scientific, non-financial support from Bayer, non-financial support from Thermofisher, non-financial support from Vifor Pharma, other from Bayer, Novartis, Takeda, Merck, Astra Zeneca, Janssen Research & Development, LLC, Menarini, Boehringer Ingelheim, Abbott Diagnostics, DC Devices, outside the submitted work. In addition, C.S.P.L. has a patent PCT/SG2016/050217 pending. A.M.R.: none relevant to the present work; is supported by a Singapore Translational Research (STaR) award from the National Medical Research Council Singapore; is a named investigator on projects supported by grants from Boston Scientific, Bayer, Astra Zeneca, Roche Diagnostics, and has received research support in kind Thermo Fisher, Roche",

year = "2019",

month = mar,

doi = "10.1002/ejhf.1358",

language = "English (US)",

volume = "21",

pages = "297--307",

journal = "European Journal of Heart Failure",

issn = "1388-9842",

publisher = "Oxford University Press",

number = "3",

}

TY - JOUR

T1 - Impact of diabetes and sex in heart failure with reduced ejection fraction patients from the ASIAN-HF registry

AU - on behalf of the ASIAN-HF Investigators

AU - Chandramouli, Chanchal

AU - Teng, Tiew Hwa Katherine

AU - Tay, Wan Ting

AU - Yap, Jonathan

AU - MacDonald, Michael R.

AU - Tromp, Jasper

AU - Yan, Limin

AU - Siswanto, Bambang

AU - Reyes, Eugenio B.

AU - Ngarmukos, Tachapong

AU - Yu, Cheuk Man

AU - Hung, Chung Lieh

AU - Richards, A. Mark

AU - Ling, Lieng Hsi

AU - Regensteiner, Judith G.

AU - Lam, Carolyn S.P.

AU - Mark Richards, A.

AU - Lam, Carolyn S.P.

AU - Hung, Chung Lieh

AU - Ling, Lieng Hsi

AU - Liew, Houng Bang

AU - Narasimhan, Calambur

AU - Ngarmukos, Tachapong

AU - Park, Sang Weon

AU - Reyes, Eugenio

AU - Anand, Inder

AU - Shimizu, Wataru

AU - Anand, Inder

N1 - Funding Information: The ASIAN-HF study ASIAN-HF is supported by grants from Boston Scientific Investigator Sponsored Research Program, National Medical Research Council of Singapore [NMRC/CSA/0052/2013], A*STAR Biomedical Research Council ATTRaCT program [SPF2014/003] and Bayer. ClinicalTrials.gov Identifier: NCT01633398. Conflict of interest: C.S.P.L: none relevant to the present work. Unrelated to the present work, C.S.P.L. is supported by a Clinician Scientist Award from the National Medical Research Council Singapore, non-financial support from Boston Scientific, non-financial support from Bayer, non-financial support from Thermofisher, non-financial support from Vifor Pharma, other from Bayer, Novartis, Takeda, Merck, Astra Zeneca, Janssen Research & Development, LLC, Menarini, Boehringer Ingelheim, Abbott Diagnostics, DC Devices, outside the submitted work. In addition, C.S.P.L. has a patent PCT/SG2016/050217 pending. A.M.R.: none relevant to the present work; is supported by a Singapore Translational Research (STaR) award from the National Medical Research Council Singapore; is a named investigator on projects supported by grants from Boston Scientific, Bayer, Astra Zeneca, Roche Diagnostics, and has received research support in kind Thermo Fisher, Roche

PY - 2019/3

Y1 - 2019/3

N2 - 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.

AB - 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.

KW - Asia

KW - Diabetes

KW - Heart failure

KW - Sex differences

KW - Women

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

Abstract

Bibliographical note

Keywords

UN SDGs

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