American Diabetes Association
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Microvascular burden and incident heart failure among middle-aged and older adults with type 1 or type 2 diabetes

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posted on 2022-08-09, 20:22 authored by Fu-Rong Li, Daniel Nyarko Hukportie, Jing Yang, Huan-Huan Yang, Guo-Chong Chen, Xian-Bo Wu



To examine association between microvascular disease (MVD) and risk of heart failure (HF) among individuals with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM).


We included 1,713 and 28,624 participants with T1DM and T2DM, respectively, from the UK Biobank who were free of HF during enrolment. MVD burden reflected by the presence of retinopathy, peripheral neuropathy, and chronic kidney disease (CKD) at baseline was prospectively evaluated for the association with incidence of HF. Hazards ratios (HRs) and 95% confidence intervals (CIs) of HF were estimated by Cox regression models adjusted for multiple traditional risk factors.


There were 145 and 2,515 incident cases of HF recorded among participants with T1DM and T2DM, respectively, during a median follow-up of 11.5 years. The association between the number of MVD and HF was stronger among participants with T1DM than among those with T2DM (P for interaction <0.001). Compared with participants with no MVD, those with all three MVD had an adjusted HR (95% CI) of 11.37 (5.62, 22.99) in T1DM and 3.66 (2.74, 4.88) in T2DM. In T1DM, HRs (CIs) were 2.69 (1.75, 4.14) for retinopathy, 2.11 (1.38, 3.23) for peripheral neuropathy, and 2.21 (1.53, 3.18) for CKD. The corresponding estimates in T2DM were 1.24 (1.13, 1.36), 1.63 (1.36, 1.96), and 1.73 (1.59, 1.89), respectively.


While a heavier burden of MVD was associated with excess risk of HF both in T1DM and T2DM, the association was evidently more pronounced in T1DM.


This study was supported by the National Natural Science Foundation of China (82173607), the Guangdong Basic and Applied Basic Research Foundation (2021A1515011684), Open Project of the Guangdong Provincial Key Laboratory of Tropical Disease Research (2020B1212060042) and Guangzhou Science and Technology Project (202102080597).