Among adults with T2D, frailty was an independent risk factor for heart failure (HF), and higher frailty burden was significantly linked with a greater risk for overall HF.
“People with T2D have double the risk for developing heart failure (HF) compared with those without T2D, and older adults with T2D commonly have frailty,” explains Ambarish Pandey, MD, MSCS. “However, the association of frailty with the risk for developing HF and its subtypes, HF with preserved (HFpEF) or reduced (HFrEF) ejection fraction, has not been fully evaluated in older adults with T2D. Additionally, it is not well established whether changes in the burden of frailty over time were linked with the risk for HF in patients with T2D.”
For a study published in the Journal of Gerontology: Medical Sciences, Dr. Pandey and colleagues sought to evaluate whether frailty was an independent risk factor for HF in T2D. “This would help us better understand whether frailty can be targeted for interventions in future research,” Dr. Pandey says.
Increased in Frailty Burden Linked With Higher Risk for HF
Dr. Pandey and colleagues conducted a secondary analysis of the Look AHEAD (Action for Health in Diabetes) trial, a multicenter, randomized controlled trial that included 5,145 participants with T2D and overweight or obesity. They assessed the frailty of participants in the trial using established methods and the deficit of accumulation frailty index (FI) that includes several health factors across multiple domains. Adjusted Cox models were used to determine the link between baseline and longitudinal changes (1- and 4-year follow-up) in FI with risk for overall HF, HFpEF (EF ≥50%), and HFrEF (EF <50%), independent of other risk factors and cardiorespiratory fitness.
The Look AHEAD trial included individuals aged 45-76 without prevalent HF. Among 5,100 participants with T2D, 257 developed HF over a median follow-up of 12.4 years. Among participants with repeat measures of FI at 1- and 4-year follow-up, an increase in frailty burden was associated with a higher risk for HFpEF (HR [95% CI] per 1-SD increase in FI at 4 years: 1.78 [1.35–2.34]), but not HFrEF after adjustment for other confounders.
‘Worsening Frailty Associated With the Highest Risk for HF’
Among adults with T2D, frailty was an independent risk factor for HF, Dr. Pandey and colleagues observed.
Within HF subtypes, higher baseline FI was notably linked with risk for HFpEF (HR [95% CI] per 1-SD higher FI: 1.37 [1.15–1.63]) but not HFrEF (HR [95% CI]: 1.19 [0.96–1.46]) after adjustment for potential confounders, including traditional HF risk factors. In individuals with repeat measures of FI at 1- and 4-year follow-up, an increase in frailty burden correlated with a higher risk for HFpEF (HR [95% CI] per 1-SD increase in FI at 4 years: 1.78 [1.35–2.34]) but not HFrEF after adjustment for other confounders (Table).
“During the 4-year follow-up, we observed that worsening frailty was associated with the highest risk for HF,” Dr. Pandey notes. “These high-risk patients may be more likely to benefit from effective interventions to prevent HF.”
The study team concurs that frailty may be a modifiable risk factor for HF for patients with T2D. “In future studies, we need to examine whether interventions targeting frailty, such as physical training, can significantly reduce the risk for developing HR among older adults with T2D and frailty,” Dr. Pandey says.
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