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US team identifies heart failure risk factor in type 1 diabetes

heart failure and type 1 diabetes

People with type 1 diabetes are at an increased risk of developing heart failure, researchers have said.

A US team say those who have poor glycemic control are even more likely to experience some form of cardiovascular disease when compared to the general public.

Dr Myra Lipes, Investigator in the Section on Immunobiology at Joslin Diabetes Center at Harvard Medical School, said: “Heart failure in particular has recently been recognised as an important complication of type 1 with national register-based studies showing tenfold increased risk of heart failure in individuals with poor glycaemic control.

“In addition, there’s a higher case fatality rate in type 1 than type 2 diabetes, which suggests different mechanisms for heart failure might be involved in type 1 diabetes.”

Dr Lipes has been trying to find ways to identify the underlying cause of heart failure among those with type 1 diabetes.

Her team have discovered that autoantibodies found against heart muscle proteins increased the volume of the heart’s main pumping chamber, which increased muscle mass, and reduced pumping function. These are features that are commonly linked with a higher risk of failure in the general population.

Previous work carried out by Dr Lipes’ team have shown that weakened heart muscle, called cardiomyopathy, and early heart failure is associated with autoantibodies being directed against heart muscle proteins.

The most recent study was all about building on those findings involving the circulating autoantibodies.

They used data collected from people involved in Diabetes Control and Complications Trial (DCCT) Epidemiology of Diabetes Interventions and Complications (EDIC) follow-up study.

All participants had lived with type 1 diabetes for about 28 years and all of them underwent the process of cardiovascular magnetic resonance imaging (CMR), which produces detailed pictures of the structures within the cardiovascular system.

Dr Lipes said: “In the study, we measured autoantibodies to heart muscle proteins in blood samples taken from the time of CMR imaging in 892 EDIC participants without any known cardiovascular disease.

“And then we examined where the presence of cardiac antibodies was associated with CMR evidence of myocardial dysfunction.”

Their findings showed the presence of cardiac autoantibodies successfully identified those who had not managed their blood sugar levels well in the past. Also, those who had these autoantibodies had dilated hearts.

Dr Lipes said: “This points to a novel process involving the heart and linked to poor glycaemic control in type 1 diabetes.

“Given the high burden of heart failure in type 1 diabetes, cardiac antibodies may enable the early identification of people at higher risk of developing heart failure.

“And, of course, understanding the underlying cause of heart failure is important since it could lead to targeted therapeutic approaches to improve outcomes in these patients.”

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