Comprehensive Multiple Risk Factor Control in Type 2 Diabetes to Mitigate Heart Failure Risk: Insights from a Prospective Cohort Study
This study evaluates the impact of comprehensive risk factor control on heart failure (HF) risk and HF-free survival time in individuals with type 2 diabetes (T2D).
RESEARCH DESIGN AND METHODS
This prospective study included 11,949 individuals diagnosed with T2D, matched with 47,796 non-T2D controls from the UK Biobank cohort. The degree of comprehensive risk factor control was assessed based on the major cardiovascular risk factors, including blood pressure, body mass index (BMI), low-density lipoprotein cholesterol, hemoglobin A1c, renal function, smoking, diet, and physical activity. Cox proportional hazards models were utilized to measure the associations between the degree of risk factor control and HF risk. Irwin’s restricted mean was employed to evaluate HF-free survival time.
RESULTS
During a median follow-up of 12.3 years, 702 (5.87%) individuals with T2D and 1,402 (2.93%) matched controls developed HF. Each additional risk factor controlled was associated with an average 19% lower risk of HF. Optimal control of ≥6 risk factors was associated with a 67% lower HF risk (HR 0.33; 95% CI 0.20, 0.54). BMI was the primary attributable risk factor for HF. Notably, the excess risk of HF associated with T2D could be attenuated to levels comparable to non-T2D controls when individuals had a high degree of risk factor control (HR 0.66; 95% CI 0.40, 1.07), and they exhibited a longer HF-free survival time.
CONCLUSIONS
Comprehensive management of risk factor is inversely associated with HF risk, and optimal risk factor control may prolong HF-free survival time among individuals with T2D.
