Association of fasting glucose with lifetime risk of incident heart failure: the Lifetime Risk Pooling Project

Abstract

Background Given the rising prevalence of dysglycemia and disparities in heart failure (HF) burden, we determined race- and sex-specific lifetime risk of HF across the spectrum of fasting plasma glucose (FPG). Methods Individual-level data from adults without baseline HF was pooled from 6 population-based cohorts. Modified Kaplan–Meier analysis, Cox models adjusted for the competing risk of death, and Irwin’s restricted mean were used to estimate the lifetime risk, adjusted hazard ratio (aHR), and years lived free from HF in middle-aged (40–59 years) and older (60–79 years) adults with FPG < 100 mg/dL, prediabetes (FPG 100–125 mg/dL) and diabetes (FPG ≥ 126 mg/dL or on antihyperglycemic agents) across race-sex groups. Results In 40,117 participants with 638,910 person-years of follow-up, 4846 cases of incident HF occurred. The lifetime risk of HF was significantly higher among middle-aged White adults and Black women with prediabetes (range: 6.1% [95% CI 4.8%, 7.4%] to 10.8% [95% CI 8.3%, 13.4%]) compared with normoglycemic adults (range: 3.5% [95% CI 3.0%, 4.1%] to 6.5% [95% CI 4.9%, 8.1%]). Middle-aged Black women with diabetes had the highest lifetime risk (32.4% [95% CI 26.0%, 38.7%]) and aHR (4.0 [95% CI 3.0, 5.4]) for HF across race-sex groups. Middle-aged adults with prediabetes and diabetes lived on average 0.9–1.6 and 4.1–6.0 fewer years free from HF, respectively. Findings were similar in older adults except older Black women with prediabetes did not have a higher lifetime risk of HF. Conclusions Prediabetes was associated with higher lifetime risk of HF in middle-aged White adults and Black women, with the association attenuating in older Black women. Black women with diabetes had the highest lifetime risk of HF compared with other race-sex groups.

Dietary Supplementation with Inulin Modulates the Gut Microbiota and Improves Insulin Sensitivity in Prediabetes

“…Additionally, prediabetic dysglycaemia increases the risk of long-term microvascular and macrovascular complications of diabetes, such as cardiovascular disease and stroke [6,7].…”

“…Despite prediabetes often being asymptomatic, there is a high risk of progression to type 2 diabetes in those patients [ 5 ]. Additionally, prediabetic dysglycaemia increases the risk of long-term microvascular and macrovascular complications of diabetes, such as cardiovascular disease and stroke [ 6 , 7 ].…”

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

“…levels represent a direct risk factor for cardiovascular diseases, of increasing value from prediabetes to diabetes, to insulin-treated diabetes [5,6]. However, the cardiovascular risk gradually increases with increases in blood pressure regardless of the presence of and of the degree of glucose abnormality [7].…”

Prediabetes and risk of heart failure: the link grows stronger

“…In a recently published paper in Cardiovascular Diabetology , Sinha et al [ 7 ] analyzed 40,117 participants from 6 population-based cohorts in the United States. They found that prediabetes (defined as an FPG concentration of 100–125 mg/dL) was associated with a higher lifetime risk of heart failure in middle-aged White adults and Black women, whereas the association was attenuated in older Black women [ 7 ]. This study strongly supports the notion that prediabetes should be regarded not only as a high-risk state for the development of diabetes but also as a risk factor for cardiovascular morbidity.…”

“…This study strongly supports the notion that prediabetes should be regarded not only as a high-risk state for the development of diabetes but also as a risk factor for cardiovascular morbidity. Interestingly, at almost the same time as publication of the study by Sinha et al [ 7 ], Cai et al [ 8 ] published a meta-analysis showing that the risk of heart failure was higher in individuals with prediabetes than in those with normoglycemia. That meta-analysis included 15 observational studies comprising nearly 10 million individuals with a median follow-up duration of 8.0 years for analysis [ 8 ].…”