Prediction of heart failure as the first major cardiovascular disease event in type 2 diabetes

AIMS: Heart failure (HF) may develop in type 2 diabetes without prior cardiovascular disease (CVD). This study aimed to identify risk factors that distinguish CVD that presents first as a HF event versus CVD that presents first as an atherosclerotic event (ASCVD), among people with type 2 diabetes. MATERIALS AND METHODS: ORIGIN and REWIND trial participants with type 2 diabetes but free of CVD (N = 6175; 64 ± 7 years, 50.1% female) were followed for ~5.8 years for incident CVD presenting first as either a HF event (HF hospitalization or HF death), ASCVD (myocardial infarction, unstable angina, stroke, or revascularization), or other cardiovascular death. Multi-state models characterised event-specific associations of risk factors with each possible first CVD event. RESULTS: HF was the first event in 16.8% of 1024 incident CVD cases. Older age, higher BMI, and higher urine albumin:creatinine ratio were more strongly associated with CVD manifesting first as HF, rather than as ASCVD or other cardiovascular death. ASCVD as the first event (65.2% of cases) was more strongly associated with worse LDL-cholesterol and HbA1c. These unique associations of risk factors with HF versus ASCVD translated to variable probabilities of HF as the first CVD event, depending on the clinical profile (32.0% for a profile enriched with HF-specific risk factors versus 5.1% for a profile enriched with ASCVD-specific risk factors). CONCLUSIONS: CVD that presents first as a HF event is common in type 2 diabetes and its risk factors are distinct from those associated with CVD that presents first as an ASCVD event.