ESC Congress 2017 In Review -- Main Edition - 26

Selected Content

Effect of Diabetes on Acute and Chronic HF
According to Ovidiu Chioncel, MD, PhD, Carol Davila
University of Medicine and Pharmacy, Bucharest,
Romania, diabetes is highly prevalent in patients hospitalised for acute HF (AHF; about 49%) and ambulatory
chronic HF (CHF; about 31%). He shared recent data
from the European Society of Cardiology and Heart
Failure Association Long-Term Registry, a prospective,
observational study collecting epidemiological information and 1 -year follow-up data in AHF and CHF patients,
including 211 cardiology centres from 21 European
and Mediterranean countries, all members of the ESC
[Chioncel O et al. Eur J Heart Fail. 2017; Targher G et al.
Eur J Heart Fail. 2017].
In AHF patients, diabetes was an independent predictor of in-hospital death (HR, 1.77; 95% CI, 1.28 to 2.45)
and 1-year all-cause mortality (HR, 1.16; 95% CI, 1.02 to
1.32; P < .0001 for between-group differences; Figure 1).

October 2017

Figure 1. Effect of Diabetes on Outcomes in Acute Heart Failure
Stronger association for in-hospital mortality
Diabetic patients (n = 3,422)
Non-diabetic patients (n = 3,504)
HR = 1.16 (1.02-1.32)

Percentage of Patients

diabetes as a risk factor that promotes iron overload,
others have also shown that some diabetes patients may
be iron deficient [Ponikowska B et al. Diabetes Care. 2013].
Marcin Drozd, MD, Wroclaw Medical University, Wroclaw,
Poland, and colleagues therefore performed a study
to assess if the concomitance of diabetes mellitus in
patients with HF and EF ≤45% affects iron status established based on standard and novel circulating biomarkers (soluble transferrin receptor [sTfR] and hepcidin)
[Drozd M et al. Eur Heart J. 2017].
The study included 622 men with stable HFrEF, 188
(30%) of whom also had diabetes. The prevalences of
iron deficiency (25% vs 20%), anaemia (8% vs 10%),
and iron deficiency anaemia (9% vs 13%) were similar
in those with and without diabetes (P = .2).
Levels of sTfR and hepcidin were abnormal in 50%
of HFrEF patients with diabetes, compared with 25% of
those without diabetes. Compared with HFrEF patients
without diabetes, those with diabetes had higher sTfR
levels (25% vs 41%) and lower hepcidin levels (5% vs
18%; P = .01 for both).
Transferrin saturation (TSAT) and sTfR levels correlated with left ventricular EF only in patients without
diabetes, Dr Drozd added.
However, there were no differences in haematinic
parameters between the 2 patient groups, and erythropoiesis was preserved in the whole study cohort.
Although the presence of iron deficiency using standard biomarkers such as ferritin and TSAT did not differ
between HF patients with and without diabetes, Dr Drozd
emphasised that changes in the novel markers sTfR and
hepcidin may indicate differences between the 2 groups.
Patients with diabetes are prone to having low hepcidin
(reflective of depleted iron stores) and high sTfR levels
(reflective of intracellular iron depletion), he said, despite
having similar levels of ferritin and TSAT.

27.5

P = .0001 for between group differences
24

23.2
18.5

20
15.9
15
10
5
0

HR = 1.77 (1.28-2.45)

6.8
4.4

In-hospital death

1-yr all-cause death

1-yr cardiac death 1-yr HF rehospitalisation

Outcomes

Reprinted from Targher G et al. In-hospital and 1-year mortality associated with
diabetes in patients with acute heart failure: results from the ESC-HFA Heart Failure Long-Term Registry. Eur J Heart Fail. 2017;19(1):54-65. doi: 10.1002/ejhf.679.
By permission of Oxford University Press on behalf of the European Society of
Cardiology.

However, in CHF patients, diabetes was an independent predictor of 1-year all-cause mortality only in
patients with reduced EF (< 40%; OR, 1.419; 95% CI,
1.160 to 1.735; P = .0007).
The results showed no graded relationship between
baseline levels of glycaemia and outcomes. Interestingly,
however, the study found a west-to-east gradient in diabetes prevalence in patients with AHF and CHF in different geographic regions, Dr Chioncel added.
The results of this study therefore provide important
new insights into the impact of diabetes on outcomes of
patients with AHF and CHF.

Lowering Cholesterol in Primary
and Secondary CV Prevention
Written by Maria Vinall

John B. Kostis, MD, Cardiovascular Institute, Rutgers
Robert Wood Johnson Medical School, New Brunswick,
New Jersey, USA, reviewed some of the studies examining the relationship between statin use and cataracts
in the Cholesterol-lowering Therapy for Primary and
Secondary Prevention session on 29 August 2017. This
became an issue during the development of lovastatin,
when it was noted that dogs given very high doses of
statins developed cataracts.
The connection was suggested to be related to the
very high cholesterol content of the lens fibre and bidirectional effects of statins on oxidation and inhibition
of appropriate lens epithelial cell development that
may promote cataract development [Dobrzynski JM,
Kostis JB. Curr Atherosceler Rep. 2015]. Publications

www.escardio.org/ESCcongressinreview

http://www.escardio.org/ESCcongressinreview

Table of Contents for the Digital Edition of ESC Congress 2017 In Review -- Main Edition