title: Prediction of heart failure in patients with type 2 diabetes mellitus- a systematic review and meta-analysis.
abstract: BACKGROUND
  Heart failure (HF) is a major cause of mortality and disability in type 2 diabetes mellitus (T2DM). This study sought to improve the assessment of HF risk in patients with T2DM-a step that would be critical for effective HF screening.
  
  
  METHODS
  A systematic literature search was performed on electronic databases including MEDLINE and EMBASE, using MeSH terms 'heart failure', 'risk factor', 'T2DM', 'cardiac dysfunction', 'stage B heart failure', 'incident heart failure', 'risk assessment', 'risk impact', 'risk score', 'predictor', 'prediction' and related free text terms. The search was limited to human studies in full-length publications in English language journal from 1946 to 2014. Univariable and multivariable relative risk (RR) and hazard ratio (HR) were obtained from each study.
  
  
  RESULTS
  Twenty-one studies (n=1111,569, including 507,637 subjects with T2DM) were included in this analysis with a follow-up ranging from 1 to 12 years. Associations between incident HF and risk variables described in ≥3 studies were reported. This association was greatest for insulin use (HR 2.48; 1.24-4.99), HbA1c 7.0-8.0% (2.41; 1.62-3.59), 5 years increase in age (1.47; 1.25-1.73), fasting glucose (1.28; 1.10-1.51 per standard deviation) and HbA1c (1.18; 1.14-1.23 each 1% increase). After adjustment for confounders, there were strong associations with coronary artery disease (1.77; 1.31, 2.39), HbA1c ≥ 10% (1.66; 1.45-1.89), insulin use (1.43; 1.14-1.79), HbA1c 9.0-10.0% (1.31; 1.14-1.50), fasting glucose (1.27; 1.10-1.47 per standard deviation) and 5 years increase in age (1.26; 1.13-1.40).
  
  
  CONCLUSIONS
  Among patients with T2DM, five common clinical variables are associated with significantly increased risk of incident HF.
authors: Menzies Research Institute Tasmania, 17 Liverpool Street, Hobart, TAS, Australia.
authors: Ying
authors: Y
authors: Wang
authors: Menzies Research Institute Tasmania, 17 Liverpool Street, Hobart, TAS, Australia.
authors: Tomoko
authors: T
authors: Negishi
authors: Menzies Research Institute Tasmania, 17 Liverpool Street, Hobart, TAS, Australia.
authors: Kazuaki
authors: K
authors: Negishi
authors: Menzies Research Institute Tasmania, 17 Liverpool Street, Hobart, TAS, Australia. Electronic address: tom.marwick@utas.edu.au.
authors: Thomas H
authors: TH
authors: Marwick
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D014943:Global Health; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors
keywords: Heart failure; Predictor; Risk factors; Type 2 diabetes mellitus