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Original research
Diabetes mellitus and cardiovascular mortality across the spectrum of aortic stenosis
  1. Augustin Coisne1,2,3,
  2. David Montaigne1,
  3. Sandro Ninni1,
  4. Nicolas Lamblin4,
  5. Gilles Lemesle4,
  6. Pascal Delsart1,
  7. Alexandre Filiot5,
  8. Paul Andrey5,
  9. Pierre Balaye6,
  10. Laura Butruille1,
  11. Raphael Decoin1,
  12. Eloise Woitrain1,
  13. Juan F Granada2,3,
  14. Bart Staels1,
  15. Christophe Bauters4
  16. on behalf of the VALVENOR investigators
  1. 1Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille University Hospital Center, Lille, Hauts-de-France, France
  2. 2Cardiovascular Research Foundation, New York, New York, USA
  3. 3Skirball Center for Innovation, Cardiovascular Research Foundation, New York, New York, USA
  4. 4Univ. Lille, Inserm, CHU Lille, Institut Pasteur, Lille University Hospital Center, Lille, Hauts-de-France, France
  5. 5CHU Lille, INCLUDE: Integration Center of the Lille University Hospital for Data Exploration, Lille University Hospital Center, Lille, Hauts-de-France, France
  6. 6Univ. Lille, CHU Lille, ULR 2694—METRICS: Évaluation des Technologies de santé et des Pratiques médicales, F-59000, Lille University Hospital Center, Lille, Hauts-de-France, France
  1. Correspondence to Dr Augustin Coisne, Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, Lille University Hospital Center, F-59000 Lille, Hauts-de-France, France; augustincoisne{at}hotmail.com

Abstract

Objective Current data regarding the impact of diabetes mellitus (DM) on cardiovascular mortality in patients with aortic stenosis (AS) are restricted to severe AS or aortic valve replacement (AVR) trials. We aimed to investigate cardiovascular mortality according to DM across the entire spectrum of outpatients with AS.

Methods Between May 2016 and December 2017, patients with mild (peak aortic velocity=2.5–2.9 m/s), moderate (3–3.9 m/s) and severe (≥4 m/s) AS graded by echocardiography were included during outpatient cardiology visits in the Nord-Pas-de-Calais region in France and followed-up for modes of death between May 2018 and August 2020.

Results Among 2703 patients, 820 (30.3%) had DM, mean age was 76±10.8 years with 46.6% of women and a relatively high prevalence of underlying cardiovascular diseases. There were 200 cardiovascular deaths prior to AVR during the 2.1 years (IQR 1.4–2.7) follow-up period. In adjusted analyses, DM was significantly associated with cardiovascular mortality (HR=1.40, 95% CI 1.04 to 1.89; p=0.029). In mild or moderate AS, the cardiovascular mortality of patients with diabetes was similar to that of patients without diabetes. In severe AS, DM was associated with higher cardiovascular mortality (HR=2.65, 95% CI 1.50 to 4.68; p=0.001). This was almost exclusively related to a higher risk of death from heart failure (HR=2.61, 95% CI 1.15 to 5.92; p=0.022) and sudden death (HR=3.33, 95% CI 1.28 to 8.67; p=0.014).

Conclusion The effect of DM on cardiovascular mortality varied across AS severity. Despite no association between DM and outcomes in patients with mild/moderate AS, DM was strongly associated with death from heart failure and sudden death in patients with severe AS.

  • Aortic Valve Stenosis
  • Heart Failure
  • Epidemiology
  • Diabetes Mellitus

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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Footnotes

  • Twitter @AugustinCoisne

  • Collaborators VALVENOR Investigators. For the full list of names, please see online supplemental file 2.

  • Contributors All the undersigning authors have substantially contributed to the paper. AC, DM and CB designed the trial and wrote the manuscript. CB performed statistical analyses. All authors reviewed the paper. All the undersigning authors have substantially contributed to the paper. AC, DM and CB designed the trial and wrote the manuscript. CB performed statistical analyses. All authors reviewed the paper. CB is acting as guarantor.

  • Funding This study was supported by a grant from Fédération Française de Cardiologie. DM is supported by grants from Agence Nationale pour la Recherche (ANR-10-LABX-0046, ANR TOMIS-Leucocyte: ANR-CE14-0003-01 and ANR CALMOS: ANR-18-CE17-0003-02), the Leducq Foundation LEAN Network 16CVD01 and the National Centre for Precision Diabetic Medicine—PreciDIAB (ANR-18-IBHU-0001; 20001891/NP0025517 /NP0025517; 2019_ESR_11).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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