Comparison of Outcomes in Patients With Diabetes Mellitus Treated With Versus Without Insulin + Heart Failure With Preserved Left Ventricular Ejection Fraction (from the TOPCAT Study)

Thao Huynh, Brian J. Harty, Brian Claggett, Jerome L. Fleg, Sonja M. McKinlay, Inder S. Anand, Eldrin F. Lewis, Jacob Joseph, Akshay S. Desai, Nancy K Sweitzer, EileenO'Meara, Bertram Pitt, Marc A. Pfeffer, Jean Lucien Rouleau

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

We aimed to evaluate the impact of diabetes mellitus (DM) and insulin treatment on clinical outcomes in patients with heart failure and preserved left ventricular ejection fraction enrolled in the TOPCAT study. We investigated the influence of DM status (insulin-treated [ITDM], non-insulin treated [NITDM], and no diabetes [non-DM]) at baseline on time to development of the primary end point, a composite of cardiovascular (CV) mortality, heart failure hospitalization, and aborted cardiac arrest. Secondary end points included the individual components of the primary end point, myocardial infarction, stroke, all-cause mortality, hyperkalemia, and worsened renal function. Due to marked regional differences in characteristics and outcomes of the TOPCAT patients, with much lower events in patients enrolled in Russia/Georgia, we restricted our analyses on findings from patients enrolled from the Americas. Compared to patients without DM, patients with ITDM had approximately 2-fold increased risk for the primary end point, heart failure hospitalization, and myocardial infarction (hazard ratios: 1.80, 1.97, and 2.27, respectively) and approximately 50% increases in all-cause and CV mortality. The risks for these outcomes were also increased in patients with ITDM in comparison to patients with NITDM as well (hazard ratios: 1.63, 1.65, and 2.73, respectively, and approximately 40% increases in all-cause and CV mortality). Patients with NITDM had similar risks for the primary end point and all secondary end points as patients without DM. In conclusion, the apparent increased risk of adverse outcomes in patients with heart failure and preserved left ventricular ejection fraction and ITDM merits future research to improve the prognosis of these high-risk patients.

Original languageEnglish (US)
Pages (from-to)611-617
Number of pages7
JournalAmerican Journal of Cardiology
Volume123
Issue number4
DOIs
StatePublished - Feb 15 2019

Fingerprint

Stroke Volume
Diabetes Mellitus
Heart Failure
Insulin
Mortality
Hospitalization
Myocardial Infarction
Hyperkalemia
Russia
Heart Arrest
Stroke
Kidney

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of Outcomes in Patients With Diabetes Mellitus Treated With Versus Without Insulin + Heart Failure With Preserved Left Ventricular Ejection Fraction (from the TOPCAT Study). / Huynh, Thao; Harty, Brian J.; Claggett, Brian; Fleg, Jerome L.; McKinlay, Sonja M.; Anand, Inder S.; Lewis, Eldrin F.; Joseph, Jacob; Desai, Akshay S.; Sweitzer, Nancy K; EileenO'Meara; Pitt, Bertram; Pfeffer, Marc A.; Rouleau, Jean Lucien.

In: American Journal of Cardiology, Vol. 123, No. 4, 15.02.2019, p. 611-617.

Research output: Contribution to journalArticle

Huynh, T, Harty, BJ, Claggett, B, Fleg, JL, McKinlay, SM, Anand, IS, Lewis, EF, Joseph, J, Desai, AS, Sweitzer, NK, EileenO'Meara, Pitt, B, Pfeffer, MA & Rouleau, JL 2019, 'Comparison of Outcomes in Patients With Diabetes Mellitus Treated With Versus Without Insulin + Heart Failure With Preserved Left Ventricular Ejection Fraction (from the TOPCAT Study)', American Journal of Cardiology, vol. 123, no. 4, pp. 611-617. https://doi.org/10.1016/j.amjcard.2018.11.022
Huynh, Thao ; Harty, Brian J. ; Claggett, Brian ; Fleg, Jerome L. ; McKinlay, Sonja M. ; Anand, Inder S. ; Lewis, Eldrin F. ; Joseph, Jacob ; Desai, Akshay S. ; Sweitzer, Nancy K ; EileenO'Meara ; Pitt, Bertram ; Pfeffer, Marc A. ; Rouleau, Jean Lucien. / Comparison of Outcomes in Patients With Diabetes Mellitus Treated With Versus Without Insulin + Heart Failure With Preserved Left Ventricular Ejection Fraction (from the TOPCAT Study). In: American Journal of Cardiology. 2019 ; Vol. 123, No. 4. pp. 611-617.
@article{90cea7f237b142ccb06b9f2b02f6af7a,
title = "Comparison of Outcomes in Patients With Diabetes Mellitus Treated With Versus Without Insulin + Heart Failure With Preserved Left Ventricular Ejection Fraction (from the TOPCAT Study)",
abstract = "We aimed to evaluate the impact of diabetes mellitus (DM) and insulin treatment on clinical outcomes in patients with heart failure and preserved left ventricular ejection fraction enrolled in the TOPCAT study. We investigated the influence of DM status (insulin-treated [ITDM], non-insulin treated [NITDM], and no diabetes [non-DM]) at baseline on time to development of the primary end point, a composite of cardiovascular (CV) mortality, heart failure hospitalization, and aborted cardiac arrest. Secondary end points included the individual components of the primary end point, myocardial infarction, stroke, all-cause mortality, hyperkalemia, and worsened renal function. Due to marked regional differences in characteristics and outcomes of the TOPCAT patients, with much lower events in patients enrolled in Russia/Georgia, we restricted our analyses on findings from patients enrolled from the Americas. Compared to patients without DM, patients with ITDM had approximately 2-fold increased risk for the primary end point, heart failure hospitalization, and myocardial infarction (hazard ratios: 1.80, 1.97, and 2.27, respectively) and approximately 50{\%} increases in all-cause and CV mortality. The risks for these outcomes were also increased in patients with ITDM in comparison to patients with NITDM as well (hazard ratios: 1.63, 1.65, and 2.73, respectively, and approximately 40{\%} increases in all-cause and CV mortality). Patients with NITDM had similar risks for the primary end point and all secondary end points as patients without DM. In conclusion, the apparent increased risk of adverse outcomes in patients with heart failure and preserved left ventricular ejection fraction and ITDM merits future research to improve the prognosis of these high-risk patients.",
author = "Thao Huynh and Harty, {Brian J.} and Brian Claggett and Fleg, {Jerome L.} and McKinlay, {Sonja M.} and Anand, {Inder S.} and Lewis, {Eldrin F.} and Jacob Joseph and Desai, {Akshay S.} and Sweitzer, {Nancy K} and EileenO'Meara and Bertram Pitt and Pfeffer, {Marc A.} and Rouleau, {Jean Lucien}",
year = "2019",
month = "2",
day = "15",
doi = "10.1016/j.amjcard.2018.11.022",
language = "English (US)",
volume = "123",
pages = "611--617",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Comparison of Outcomes in Patients With Diabetes Mellitus Treated With Versus Without Insulin + Heart Failure With Preserved Left Ventricular Ejection Fraction (from the TOPCAT Study)

AU - Huynh, Thao

AU - Harty, Brian J.

AU - Claggett, Brian

AU - Fleg, Jerome L.

AU - McKinlay, Sonja M.

AU - Anand, Inder S.

AU - Lewis, Eldrin F.

AU - Joseph, Jacob

AU - Desai, Akshay S.

AU - Sweitzer, Nancy K

AU - EileenO'Meara,

AU - Pitt, Bertram

AU - Pfeffer, Marc A.

AU - Rouleau, Jean Lucien

PY - 2019/2/15

Y1 - 2019/2/15

N2 - We aimed to evaluate the impact of diabetes mellitus (DM) and insulin treatment on clinical outcomes in patients with heart failure and preserved left ventricular ejection fraction enrolled in the TOPCAT study. We investigated the influence of DM status (insulin-treated [ITDM], non-insulin treated [NITDM], and no diabetes [non-DM]) at baseline on time to development of the primary end point, a composite of cardiovascular (CV) mortality, heart failure hospitalization, and aborted cardiac arrest. Secondary end points included the individual components of the primary end point, myocardial infarction, stroke, all-cause mortality, hyperkalemia, and worsened renal function. Due to marked regional differences in characteristics and outcomes of the TOPCAT patients, with much lower events in patients enrolled in Russia/Georgia, we restricted our analyses on findings from patients enrolled from the Americas. Compared to patients without DM, patients with ITDM had approximately 2-fold increased risk for the primary end point, heart failure hospitalization, and myocardial infarction (hazard ratios: 1.80, 1.97, and 2.27, respectively) and approximately 50% increases in all-cause and CV mortality. The risks for these outcomes were also increased in patients with ITDM in comparison to patients with NITDM as well (hazard ratios: 1.63, 1.65, and 2.73, respectively, and approximately 40% increases in all-cause and CV mortality). Patients with NITDM had similar risks for the primary end point and all secondary end points as patients without DM. In conclusion, the apparent increased risk of adverse outcomes in patients with heart failure and preserved left ventricular ejection fraction and ITDM merits future research to improve the prognosis of these high-risk patients.

AB - We aimed to evaluate the impact of diabetes mellitus (DM) and insulin treatment on clinical outcomes in patients with heart failure and preserved left ventricular ejection fraction enrolled in the TOPCAT study. We investigated the influence of DM status (insulin-treated [ITDM], non-insulin treated [NITDM], and no diabetes [non-DM]) at baseline on time to development of the primary end point, a composite of cardiovascular (CV) mortality, heart failure hospitalization, and aborted cardiac arrest. Secondary end points included the individual components of the primary end point, myocardial infarction, stroke, all-cause mortality, hyperkalemia, and worsened renal function. Due to marked regional differences in characteristics and outcomes of the TOPCAT patients, with much lower events in patients enrolled in Russia/Georgia, we restricted our analyses on findings from patients enrolled from the Americas. Compared to patients without DM, patients with ITDM had approximately 2-fold increased risk for the primary end point, heart failure hospitalization, and myocardial infarction (hazard ratios: 1.80, 1.97, and 2.27, respectively) and approximately 50% increases in all-cause and CV mortality. The risks for these outcomes were also increased in patients with ITDM in comparison to patients with NITDM as well (hazard ratios: 1.63, 1.65, and 2.73, respectively, and approximately 40% increases in all-cause and CV mortality). Patients with NITDM had similar risks for the primary end point and all secondary end points as patients without DM. In conclusion, the apparent increased risk of adverse outcomes in patients with heart failure and preserved left ventricular ejection fraction and ITDM merits future research to improve the prognosis of these high-risk patients.

UR - http://www.scopus.com/inward/record.url?scp=85059437014&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85059437014&partnerID=8YFLogxK

U2 - 10.1016/j.amjcard.2018.11.022

DO - 10.1016/j.amjcard.2018.11.022

M3 - Article

C2 - 30612727

AN - SCOPUS:85059437014

VL - 123

SP - 611

EP - 617

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 4

ER -