Diabetes and heart failure associations in women and men: Results from the MORGAM consortium

Sucharitha Chadalavada; Jaakko Reinikainen; Jonas Andersson; Augusto Di Castelnuovo; Licia Iacoviello; Pekka Jousilahti; Line Lund Kårhus; Allan Linneberg; Stefan Söderberg; Hugh Tunstall-Pedoe; Karim Lekadir; Nay Aung; Magnus T Jensen; Kari Kuulasmaa; Teemu J Niiranen; Steffen E Petersen

doi:10.3389/fcvm.2023.1136764

Diabetes and heart failure associations in women and men: Results from the MORGAM consortium

Front Cardiovasc Med. 2023 Apr 25:10:1136764. doi: 10.3389/fcvm.2023.1136764. eCollection 2023.

Authors

Sucharitha Chadalavada^{1

2}, Jaakko Reinikainen³, Jonas Andersson⁴, Augusto Di Castelnuovo⁵, Licia Iacoviello^{6

7}, Pekka Jousilahti³, Line Lund Kårhus⁸, Allan Linneberg^{8

9}, Stefan Söderberg¹⁰, Hugh Tunstall-Pedoe¹¹, Karim Lekadir¹², Nay Aung^{1

2}, Magnus T Jensen^{1

13}, Kari Kuulasmaa³, Teemu J Niiranen^{3

14}, Steffen E Petersen^{1

2

15

16}

Affiliations

¹ William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom.
² Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom.
³ Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
⁴ Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Skellefteå, Sweden.
⁵ Mediterranea Cardiocentro, Naples, Italy.
⁶ Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
⁷ Research Center in Epidemiology and Preventive Medicine-EPIMED, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
⁸ Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark.
⁹ Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
¹⁰ Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
¹¹ Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, United Kingdom.
¹² Artificial Intelligence in Medicine Lab (BCN-AIM), Departament de Matemàtiques and Informàtica, Universitat de Barcelona, Barcelona, Spain.
¹³ Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, Herlev, Denmark.
¹⁴ Department of Internal Medicine, University of Turku and Turku University Hospital, Turku, Finland.
¹⁵ Health Data Research UK, London, United Kingdom.
¹⁶ National Institute for Health and Care Research, London, United Kingdom.

Abstract

Background: Diabetes and its cardiovascular complications are a growing concern worldwide. Recently, some studies have demonstrated that relative risk of heart failure (HF) is higher in women with type 1 diabetes (T1DM) than in men. This study aims to validate these findings in cohorts representing five countries across Europe.

Methods: This study includes 88,559 (51.8% women) participants, 3,281 (46.3% women) of whom had diabetes at baseline. Survival analysis was performed with the outcomes of interest being death and HF with a follow-up time of 12 years. Sub-group analysis according to sex and type of diabetes was also performed for the HF outcome.

Results: 6,460 deaths were recorded, of which 567 were amongst those with diabetes. Additionally, HF was diagnosed in 2,772 individuals (446 with diabetes). A multivariable Cox proportional hazard analysis showed that there was an increased risk of death and HF (hazard ratio (HR) of 1.73 [1.58-1.89] and 2.12 [1.91-2.36], respectively) when comparing those with diabetes and those without. The HR for HF was 6.72 [2.75-16.41] for women with T1DM vs. 5.80 [2.72-12.37] for men with T1DM, but the interaction term for sex differences was insignificant (p for interaction 0.45). There was no significant difference in the relative risk of HF between men and women when both types of diabetes were combined (HR 2.22 [1.93-2.54] vs. 1.99 [1.67-2.38] respectively, p for interaction 0.80).

Conclusion: Diabetes is associated with increased risks of death and heart failure, and there was no difference in relative risk according to sex.

Keywords: MORGAM; diabetes; epidemiology; heart failure; sex differences.

Grants and funding

This work was funded by the European Union’s Horizon 2020 research and innovation program under grant agreement no. 825903 (euCanSHare project). The MORGAM Project has received funding from EU projects MORGAM (Biomed, BMH4-CT98-3183), GenomEUtwin (FP5, QLG2-CT-2002-01254), ENGAGE (FP7, HEALTH-F4-2007-201413), CHANCES (FP7, HEALTH-F3-2010-242244), BiomarCaRE (FP7, HEALTH-F2-2011-278913), euCanSHare (Horizon 2020, No. 825903) and AFFECT-EU (Horizon 2020, No. 847770); and Medical Research Council, London (G0601463, No. 80983: Biomarkers in the MORGAM Populations). This has supported central coordination, workshops, and part of the activities of the MORGAM Data Centre, the MORGAM Laboratories and the MORGAM Participating Centers. N.A. recognizes the National Institute for Health and Care Research (NIHR) Integrated Academic Training program which supports his Academic Clinical Lectureship post.