Heart Failure And Diabetes A Threat? AHA Has The Antidote

Statistics show that cardiac ailments continue to remain a challenge in cardiology practice and cardiology management today. Research shows that one in four middle-aged adults who live to the age of 85 develop conditions with heart failure risks. A group of investigators in the US and Taiwan conducted independent programme examinations to help reduce lifetime risks of heart failure. The results of their research were published in The American Journal of Medicine.

American investigators estimated whether adoption of the American Heart Association (AHA)’s Life Simple 7 on a wider scale is associated with lower lifetime risk of heart failure and better preservation of cardiac structure and function.  

According to Dr. Aaron R Folsom, University of Minnesota and lead author of the study, the AHA programme proves indeed to be revolutionary in the field of cardiology management. He says that the study demonstrates that greater adherence to Life’s Simple 7 in middle age significantly reduces risk of heart failure and helps preserve the cardiac structure and function better. 

To live a longer and healthier life without the risk of developing cardiac conditions in middle age, AHA recommends following Life’s Simple 7 Programme, which describes ideal, intermediate and poor levels of cardiovascular disease factors: smoking, body mass index, physical activity, diet, total cholesterol, blood pressure and fasting serum glucose.  The Atherosclerosis Risk in Communities (ARIC) investigation has shown that the number of ideal Simple 7 factors achieved is reversely associated with later incidence of cardiovascular disease, heart failure and cancer. However, the degree to which applying these principles might lower lifetime heart failure risk have not been specifically approached in any cardiology management publication so far.

Relying on the data given in ARIC’s cohort study conducted on a population segment of 13,462 adults aged between 45 and 64 in 1987 – 1989, investigators developed risk factor measurements creating Life’s Simple 7 scores (eg. range 0-14 with an ideal score of 2 points, 1 point qualifying as intermediate score and 0 for poor).  Using hospital discharge surveillance and death codes, they identified 2,218 incident heart failure events through 2011. Additionally, in 2011-2013 they echocardiographed 4,855 participants, who were not clinically diagnosed with cardiovascular disease, and discovered that some of them were showing signs of ventricular hypertrophy and diastolic dysfunction.

Around 25% of the participants of this cohort study developed heart failure by the age of 85, but the risk was only 14.4% for those with an optimal middle-age Life’s Simple 7 score of 10-14 as compared to 26.8% for those with a score of 5-9 (average) and 48.6% for an inadequate score of 0-4.

In Taiwan, a group of researchers conducted a similar study seeking to evaluate the impact of participation in the Diabetes Shared Care Programme (DSCP) on the risk of cardiovascular disease incidents. This programme was conceived as an integrated care model to enhance the level of diabetic care in Taiwan. Diabetic diagnosed patients may join the programme of their own consent or enrolled by a physician provided that they meet the criteria. Investigators assessed whether the patients participating in this study presented reduced risks of cardiovascular disease, including coronary heart disease, stroke, and all-cause mortality.

Arguing in favour of the efficacy of DSCP, Dr. Chien-Ning Huang, lead investigator at Chung Medical University Hospital, Taichung says “participation in the DSCP was associated with lower risks of cardiovascular events, stroke, and all-cause mortality”. 120,000 randomly selected diabetes patients were diagnosed between October and December 2009. Those participating in the DSCP received integrated care from a physician, diabetes educator, and dietitian. Non-participants did receive medical care from a physician, but did not receive any advice from a diabetes educator and a dietitian. 

Having followed the 4,458 patients taking part in this cohort until their first hospitalisations due to cardiovascular incidents, researchers established that DSCP participation led to a 14% decline in cardiovascular disease events, a 16% reduction of stroke risk, and a 22% decrease in all-cause mortality. Older male patients having a history of hypertension, chronic lung disease and/or those who were prescribed different forms of insulin treatment presented higher cardiovascular risks. However, this was positively outweighed by better cardiovascular outcomes in patients following a treatment based on biguanides, alpha-glucosidase inhibitors, and thiazolidinediones.