Type 2 diabetes (T2D) is a prevalent comorbidity in both reduced ejection fraction (HFrEF) and preserved heart failure (HFpEF). However, comorbidities and risk factors associated with new onset of heart failure (HF), distinguishing HFrEF and HFpEF in T2D patients have never been investigated.

The objective of our study is to assess the occurrence of HF in a T2D population, to identify the clinical factors associated with HFrEF compared to HFpEF.

We retrospectively analyzed 966 T2D patients followed in our institution. New onset HF was defined as a clinical manifestation of HF or increased HF therapy. We studied the overall occurrence of HF, HFpEF (EF≥50%) and HFrEF (EF<50%).

Nine hundred sixty-six T2D patients were included (58.7±11.9 years, 368 women). Over a median follow-up of 10 years, 77 (8%) patients had a new onset HF event. HF patients were older (P<0.001), more frequently in atrial fibrillation (AF) (P<0.001) and had more cardiovascular (CV) events (P<0.001). HFpEF patients (n=27) compared to HFrEF (n=50) are significantly older (71.1±8.5 vs. 66.6±9.5 years, P=0.04) and have more comorbidities such as AF (56% vs. 32%, P=0.04), higher blood pressure (150±27 vs. 130±28mmHg, P=0.005), higher body mass index (34±6 vs. 30±5.6kg/m², P=0.004) and sleep apnea (44% vs. 28%, P<0.001). Prevalence of history of coronary artery disease is similar between HFpEF and HFrEF (33% vs. 38%, P=0.7). Interestingly, history of non-ST segment elevation myocardial infarction (NSTEMI) was comparable between HFpEF and HFrEF (19% vs. 22%, P=0.72). By contrast, none of the HFpEF patients had a history of ST elevation segment myocardial infarction (STEMI) (0% vs. 16%, P=0.03) (Fig. 1).

Patients who develop HF in the T2D population have more CV comorbidities including history of acute coronary syndrome. History of STEMI before HF is strictly associated with the occurrence of HFrEF.