Diabetes and risk of heart failure in people with and without cardiovascular disease: systematic review and meta-analysis

Background: People with diabetes have an increased risk of heart failure (HF), compared to those without diabetes. However, no comprehensive systematic review and meta-analysis has explored whether these associations could differ in relation to prevalent cardiovascular disease (CVD).Aims: To estimate the association between diabetes and incident heart failure (HF), compared to without diabetes, in individuals with and without CVD.Methods: PubMed, Scopus, and Web of Science were searched for observational cohort studies from the earliest dates to 22nd March 2023. A random-effects model calculated the pooled relative risk (RR). Results: Of 11,609 articles, 31 and 6 studies reported data in people with type 2 diabetes (T2D) and type 1 diabetes (T1D) respectively. Individuals with T2D had an increased risk of HF irrespective of CVD prevalence: 1.61 (95% CI: 1.35-1.92) in those with CVD; 1.78 (1.60-1.99) without CVD; and 2.02 (1.75-2.33) with unspecified CVD prevalence. Meta-regression did not identify a significant difference comparing HF risk in T2D individuals with vs. without CVD (p = 0.232).Conclusion: People with T2D, compared to those without diabetes, have similar increased risk of HF, regardless of CVD prevalence. Strategies proven to lower HF risk in T2D individuals should be prioritized for those with and without CVD.