Duration of Diabetes and Incident Heart Failure: The ARIC (Atherosclerosis Risk In Communities) Study.

Objectives: This study assessed the association of diabetes duration with incident heart failure (HF).
Background: Diabetes increases HF risk. However, the independent effect of diabetes duration on incident HF is unknown.
Methods: We included 9,734 participants (mean age 63 years, 58% women, 22% Black) at ARIC (Atherosclerosis Risk In Communities) Visit 4 (1996-1998) without HF or coronary heart disease. We calculated diabetes duration at Visit 4 (baseline), utilizing diabetes status at the first 4 ARIC visits spaced 3 years apart, and self-reported diagnosis date for those with diabetes diagnosed before Visit 1. We used Cox regression to estimate associations of diabetes duration with incident HF, accounting for intercurrent coronary heart disease and other risk factors. We performed analyses stratified by age (<65 years or ≥65 years), race, sex, and glycemic control (hemoglobin A _1C [HbA _1C ] consistently <7%, vs HbA _1C  ≥7%), with tests for interaction.
Results: Over 22.5 years of follow-up, there were 1,968 HF events. Compared to those without diabetes, HF risk rose with longer diabetes duration, with the highest risk among those with ≥15 y diabetes duration (HR: 2.82; 95% CI: 2.25-3.63). Each 5-year increase in diabetes duration was associated with a 17% (95% CI: 11-22) relative increase in HF risk. Similar results were observed across HF subtypes. The HF and diabetes duration associations were stronger among those aged <65 years, those with HbA _1C  ≥7%, those with a body mass index ≥30 kg/m ² , women, and Blacks (all P interactions <0.05).
Conclusions: Delaying diabetes onset may augment HF prevention efforts, and therapies to improve HF outcomes might target those with long diabetes duration.
Competing Interests: Funding Support and Author Disclosures The ARIC study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), and Department of Health and Human Services, under Contract nos. HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I. The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr Tcheugui was supported by National Institutes of Health (NIH)/NHLBI grant K23 HL153774. Dr Hamo was supported by NIH/NHLBI grant number T32 HL007024. Dr Selvin was supported by NIH/National Institute of Diabetes and Digestive and Kidney Diseases grants K24 HL152440 and R01DK089174, and American Heart Association grant 20SFRN35120152. Dr Ndumele was supported by NIH grant R01HL146907 and American Heart Association grant 20SFRN35120152. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)