Abstract P592: Risk Factors for Heart Failure Subtypes in a Population With a High Burden of Diabetes- Evidence From the Strong Heart Study

Introduction: Heart failure (HF) is a leading cause of death. Despite the high burden of CVD and diabetes affecting American Indian (AI) communities, studies of risk factors for HF and HF subtypes in AIs are lacking and critically needed to optimize prevention strategies. Hypothesis: We hypothesize that diabetes and diabetes-related complications are HF risk factors in AIs. Methods: A total of 3,066 Strong Heart Study (SHS) participants (mean age 56.3±8.1 years, 58% women, all free of CVD) recruited in 1989-91 were followed through 2017. A total of 489 participants developed HF (119 HFpEF, 68 HFmrEF, 98 HFrEF, 204 unclassified). We used Cox proportional hazards models to determine risk factors for HF and HF subtypes progressively adjusting for sociodemographic and traditional CV risk factors (Model 1) and additionally for glycated hemoglobin (HbA1c) and albuminuria (Model 2-main model). Results: HRs (95% CI) are shown in Table 1. Age, smoking status, BMI, hypertension treatment, diabetes status, HbA1c, and albuminuria were independently associated with overall HF (Model 2). Some associations differed across HF subtypes: male sex was associated with higher risk of HFrEF and potentially HFmrEF, whereas female sex was associated with higher risk of HFpEF. BMI was associated with HFpEF but not with HFmrEF and HFrEF. Higher HDL-cholesterol was negatively associated with risk of HFmrEF and HFrEF. Diabetes was consistently associated with all HF subtypes. HbA1c was significantly associated with HFmrEF and albuminuria was significantly associated with HpEF and HFrEF. The association with diabetes status was attenuated after adjustment for HbA1c and albuminuria for all forms of HF. Conclusion: Diabetes and diabetes-related complications are major risk factors for all forms of HF in the SHS. Indicators of HF risk differ across HF subtypes. Including measures of diabetes control (HbA1c) and target organ damage (albuminuria) in HF risk calculation improves risk prediction and could aid in targeting primary prevention interventions.