Diabetes mellitus is associated with low exercise capacity and impaired peripheral vasodilation in patients with heart failure - a propensity score-matched study

Miroslava Valentova, Department of Geriatrics, University Medical Center Goettingen, Germany; DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Germany. Electronic address: miroslava.valentova@med.uni-goettingen.de.
Mirela Vatic, DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Germany; Department of Cardiology an Pneumology, University Medical Center Goettingen, Germany.
Tania Garfias-Veitl, DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Germany; Department of Cardiology an Pneumology, University Medical Center Goettingen, Germany.
Anja Sandek, DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Germany; Department of Cardiology an Pneumology, University Medical Center Goettingen, Germany.
Tarek Bekfani, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, Department of Internal Medicine, University Hospital Magdeburg, Otto-von Guericke University, Magdeburg, Germany.
Ewa A. Jankowska, Centre for Heart Diseases, University Hospital, Poland, Department of Public Health, Faculty of Health Sciences, Wrocław Medical University, Poland.
John G. Cleland, School of Cardiovascular and Metabolic Health, University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, UK.
Andrew L. Clark, Department of Academic Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK.
Mitja Lainscak, Division of Cardiology, General Hospital Murska Sobota and Faculty of Medicine, University of Ljubljana, Slovenia.
Ali Ahmed, Veterans Affairs Medical Center, Washington, DC, George Washington University, Washington, DC, Georgetown University, Washington, DC, USA.
Nadja Jauert, Berlin Institute of Health Center for Regenerative Therapies (BCRT) and Deutsches Herzzentrum der Charité, Department of Cardiology Angiology and Intensive Care Medicine (Campus Virchow), Charité Universitätsmedizin Berlin, German Centre for Cardiovascular Research (DZHK) partner site Berlin, Germany; Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany; Division of Physiology, Department of Human Medicine, MSB Medical School Berlin, Berlin, Germany.
Gerd Hasenfuss, DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Germany; Department of Cardiology an Pneumology, University Medical Center Goettingen, Germany.
Stefan D. Anker, Berlin Institute of Health Center for Regenerative Therapies (BCRT) and Deutsches Herzzentrum der Charité, Department of Cardiology Angiology and Intensive Care Medicine (Campus Virchow), Charité Universitätsmedizin Berlin, German Centre for Cardiovascular Research (DZHK) partner site Berlin, Germany.
Wolfram Doehner, Berlin Institute of Health Center for Regenerative Therapies (BCRT) and Deutsches Herzzentrum der Charité, Department of Cardiology Angiology and Intensive Care Medicine (Campus Virchow), Charité Universitätsmedizin Berlin, German Centre for Cardiovascular Research (DZHK) partner site Berlin, Germany; Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany.
Stephan von Haehling, DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Germany; Department of Cardiology an Pneumology, University Medical Center Goettingen, Germany.

Document Type

Journal Article

Publication Date

9-19-2024

Journal

Diabetes research and clinical practice

Volume

217

DOI

10.1016/j.diabres.2024.111864

Keywords

Diabetes mellitus; Exercise capacity; Heart failure; Propensity score matching; Vascular function

Abstract

AIMS: Diabetes mellitus (DM) and heart failure (HF) share vascular, skeletal and metabolic abnormalities that can reduce exercise capacity. We investigated whether exercise capacity differ in patients with type 2 DM compared to those without DM with HF of similar severity. METHODS AND RESULTS: The Studies Investigating Co-morbidities Aggravating HF (SICA-HF) prospectively enrolled 615 patients with chronic HF, 259 (42.1 %) of whom had DM. We assembled a propensity score-matched cohort of 231 pairs of patients with HF with or without DM who were balanced on age, sex and variables reflecting HF severity. Patients with DM had lower median peak VO (15.7 [13.0-19.1] vs. 17.3 [14.1-21.0] ml/min/kg; p = 0.005). Forearm blood flow reserve (per 1 ml/min/100 ml increase) was associated with lower exercise capacity (peak VO2 ≤ 16.6 ml/min/kg) in patients with DM (OR, 0.92; 95 % CI, (0.85-0.98; p = 0.014), but not in those without DM (OR, 0.98; 95 % CI, 0.93-1.02). A similar heterogeneity was also observed for HDL cholesterol. CONCLUSIONS: Diabetes is associated with a reduced exercise capacity in patients with HF. Most predictors of lower exercise capacity in HF are similar regardless of DM except impaired vascular function and lower HDL cholesterol which predict lower exercise capacity only in those with DM.

Department

Medicine

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