Impact of diabetes and sex in heart failure with reduced ejection fraction patients from the ASIAN-HF registry

on behalf of the ASIAN-HF Investigators

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23 Scopus citations


AIMS: To examine sex differences in clinical characteristics, echocardiographic features, quality of life and 1-year death or heart failure (HF) hospitalization outcomes in patients with/without diabetes mellitus (DM).

METHODS AND RESULTS: Utilizing the Asian Sudden Cardiac Death in HF (ASIAN-HF) registry, 5255 patients (mean age 59.6 ± 13.1, 78% men) with symptomatic HF with reduced ejection fraction (HFrEF) were stratified by DM status to address the research aims. Despite similar prevalence of DM between Asian men (43%) and women (42%), the odds of DM increased at lower body mass index in women vs. men (≥ 23 vs. ≥ 27.5 kg/m 2 , P interaction  = 0.014). DM was more strongly related to chronic kidney disease in women vs. men [adjusted odds ratio (OR) 1.85, 95% confidence interval (CI) 1.33-2.57 vs. OR 1.32, 95% CI 1.11-1.56, P interaction  = 0.009]. Sex also modified the relationship between DM and left ventricular geometry (P interaction  = 0.003), whereby DM was associated with a more concentric left ventricular geometry in women than men. Women had lower quality of life than men (P < 0.001), in both DM and non-DM groups. DM was associated with worse composite outcomes at 1 year in women vs. men [hazard ratio (HR) 1.79, 95% CI 1.24-2.60 vs. HR 1.32, 95% CI 1.12-1.56; P interaction  = 0.005).

CONCLUSIONS: Asian women with HFrEF were more likely to have DM despite a lean body mass index, a greater burden of chronic kidney disease and more concentric left ventricular geometry, compared to men. Furthermore, DM confers worse quality of life, irrespective of sex, and a greater risk of adverse outcomes in women than men. These data underscore the need for sex-specific approaches to diabetes in patients with HF.

Original languageEnglish (US)
Pages (from-to)297-307
Number of pages11
JournalEuropean Journal of Heart Failure
Issue number3
StatePublished - Mar 2019

Bibliographical note

Funding Information:
The ASIAN-HF study ASIAN-HF is supported by grants from Boston Scientific Investigator Sponsored Research Program, National Medical Research Council of Singapore [NMRC/CSA/0052/2013], A*STAR Biomedical Research Council ATTRaCT program [SPF2014/003] and Bayer. Identifier: NCT01633398. Conflict of interest: C.S.P.L: none relevant to the present work. Unrelated to the present work, C.S.P.L. is supported by a Clinician Scientist Award from the National Medical Research Council Singapore, non-financial support from Boston Scientific, non-financial support from Bayer, non-financial support from Thermofisher, non-financial support from Vifor Pharma, other from Bayer, Novartis, Takeda, Merck, Astra Zeneca, Janssen Research & Development, LLC, Menarini, Boehringer Ingelheim, Abbott Diagnostics, DC Devices, outside the submitted work. In addition, C.S.P.L. has a patent PCT/SG2016/050217 pending. A.M.R.: none relevant to the present work; is supported by a Singapore Translational Research (STaR) award from the National Medical Research Council Singapore; is a named investigator on projects supported by grants from Boston Scientific, Bayer, Astra Zeneca, Roche Diagnostics, and has received research support in kind Thermo Fisher, Roche


  • Asia
  • Diabetes
  • Heart failure
  • Sex differences
  • Women
  • Diabetes Mellitus/epidemiology
  • Prevalence
  • Comorbidity
  • Humans
  • Middle Aged
  • Risk Factors
  • Death, Sudden, Cardiac/epidemiology
  • Male
  • Heart Failure/mortality
  • Stroke Volume
  • Echocardiography/methods
  • Sex Factors
  • Quality of Life
  • Asia/epidemiology
  • Female
  • Hospitalization/statistics & numerical data
  • Aged

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Observational Study
  • Multicenter Study
  • Journal Article


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