Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Short Communication

Volume 15, Number 3, June 2024, pages 198-204

Is Type 2 Diabetes Mellitus an Independent Risk Factor for Mortality in Hypertrophic Cardiomyopathy?

Figure 1. Kaplan-Meier survival curve analysis and log-rank test against the outcome of death (a) for cohort 1 and cohort 2 over the course of 5 years after the index event. Analyses were also conducted against the outcome of heart failure over the same period (b). T2DM: type 2 diabetes mellitus.

**Table 1.** Baseline Characteristics After Propensity Score Matching
Characteristic	Cohort 1 (no T2DM)	Cohort 2 (T2DM)	P value	Standardized mean difference
SCD: sudden cardiac death; T2DM: type 2 diabetes mellitus; LVEF: left ventricular ejection fraction; CAD: coronary artery disease; COPD: chronic obstructive pulmonary disease; BMI: body mass index; CKD: chronic kidney disease; ESRD: end-stage renal disease; Afib: atrial fibrillation; Vfib: ventricular fibrillation; HLD: hyperlipidemia; HTN: hypertension; ICD: implantable cardioverter-defibrillator device; ACEI: angiotensin-converting enzyme inhibitors; ARBs: angiotensin II receptor blockers; BP: blood pressure; BNP: B-type natriuretic peptide; BP: blood pressure; LA: left atrium.
Age, years	64 ± 15	62 ± 14	< 0.0001	0.1027
Sex
Female (%)	48.61%	48.53%	0.8870	0.0084
Male (%)	48.32%	48.46%	0.8128	0.0017
Medical history
COPD	14.21%	14.46%	0.5545	0.0070
HTN	73.61%	73.56%	0.9252	0.0011
Family history of SCD	0.40%	0.41%	0.8524	0.0022
Syncope	12.97%	12.82%	0.7108	0.0044
CAD	28.11%	28.14%	0.9580	0.0006
Smoking	18.37%	18.67%	0.5125	0.0078
CKD	19.84%	20.48%	0.1795	0.0159
Afib/flutter	18.57%	18.58%	0.9757	0.0004
ESRD	2.81%	2.90%	0.6441	0.0055
HLD	54.72%	55.34%	0.2897	0.0125
Presence of ICD	5.13%	5.09%	0.8719	0.0019
Pulmonary HTN	5.22%	5.28%	0.8113	0.0028
VT	7.12%	7.07%	0.8900	0.0016
Vfib	0.99%	0.97%	0.8568	0.0021
Procedures
Cardiac valve surgery	0.64%	0.62%	0.8229921	0.002647458
Medications
Anticoagulants	42.20%	43.06%	0.1411	0.0174
Beta blockers	55.49%	56.17%	0.2429	0.0138
ACEI	39.88%	40.40%	0.3717	0.0106
ARBs	24.22%	24.10%	0.8142	0.0028
Antilipemic agents	58.13%	58.48%	0.5565	0.0070
Antiarrhythmics	49.95%	51.34%	0.0191	0.0277
Platelet inhibitors	46.31%	46.85%	0.3548	0.0110
Results
Body mass index	29.1 ± 6.7	32.1 ± 7.2	0.0089	0.0310
Systolic BP	133 ± 21	133 ± 22	0.0921	0.0237
LVEF (%)	60.2 ± 12.2	59.5 ± 13.5	0.0224	0.0562
BNP (pg/mL)
< 100	11.11%	11.44%	0.3792	0.0104
≥ 100	12.23%	12.36%	0.7321	0.0041
eGFR (mL/min)
≥ 90	45.99%	46.93%	0.1119	0.0188
60 - 89	59.20%	59.86%	0.2521	0.0136
15 - 59	37.72%	38.07%	0.5419	0.0072
< 15	5.21%	5.23%	0.9364	0.0009
LA anteroposterior diameter	14.3 ± 17.3	17.65 ± 18.56	0.7173701	0.004283972

Table 1. Baseline Characteristics After Propensity Score Matching

Characteristic

Cohort 1 (no T2DM)

Cohort 2 (T2DM)

P value

Standardized mean difference

SCD: sudden cardiac death; T2DM: type 2 diabetes mellitus; LVEF: left ventricular ejection fraction; CAD: coronary artery disease; COPD: chronic obstructive pulmonary disease; BMI: body mass index; CKD: chronic kidney disease; ESRD: end-stage renal disease; Afib: atrial fibrillation; Vfib: ventricular fibrillation; HLD: hyperlipidemia; HTN: hypertension; ICD: implantable cardioverter-defibrillator device; ACEI: angiotensin-converting enzyme inhibitors; ARBs: angiotensin II receptor blockers; BP: blood pressure; BNP: B-type natriuretic peptide; BP: blood pressure; LA: left atrium.

Age, years

64 ± 15

62 ± 14

< 0.0001

0.1027

Sex

Female (%)

48.61%

48.53%

0.8870

0.0084

Male (%)

48.32%

48.46%

0.8128

0.0017

Medical history

COPD

14.21%

14.46%

0.5545

0.0070

HTN

73.61%

73.56%

0.9252

0.0011

Family history of SCD

0.40%

0.41%

0.8524

0.0022

Syncope

12.97%

12.82%

0.7108

0.0044

CAD

28.11%

28.14%

0.9580

0.0006

Smoking

18.37%

18.67%

0.5125

0.0078

CKD

19.84%

20.48%

0.1795

0.0159

Afib/flutter

18.57%

18.58%

0.9757

0.0004

ESRD

2.81%

2.90%

0.6441

0.0055

HLD

54.72%

55.34%

0.2897

0.0125

Presence of ICD

5.13%

5.09%

0.8719

0.0019

Pulmonary HTN

5.22%

5.28%

0.8113

0.0028

7.12%

7.07%

0.8900

0.0016

Vfib

0.99%

0.97%

0.8568

0.0021

Procedures

Cardiac valve surgery

0.64%

0.62%

0.8229921

0.002647458

Medications

Anticoagulants

42.20%

43.06%

0.1411

0.0174

Beta blockers

55.49%

56.17%

0.2429

0.0138

ACEI

39.88%

40.40%

0.3717

0.0106

ARBs

24.22%

24.10%

0.8142

0.0028

Antilipemic agents

58.13%

58.48%

0.5565

0.0070

Antiarrhythmics

49.95%

51.34%

0.0191

0.0277

Platelet inhibitors

46.31%

46.85%

0.3548

0.0110

Results

Body mass index

29.1 ± 6.7

32.1 ± 7.2

0.0089

0.0310

Systolic BP

133 ± 21

133 ± 22

0.0921

0.0237

LVEF (%)

60.2 ± 12.2

59.5 ± 13.5

0.0224

0.0562

BNP (pg/mL)

< 100

11.11%

11.44%

0.3792

0.0104

≥ 100

12.23%

12.36%

0.7321

0.0041

eGFR (mL/min)

≥ 90

45.99%

46.93%

0.1119

0.0188

60 - 89

59.20%

59.86%

0.2521

0.0136

15 - 59

37.72%

38.07%

0.5419

0.0072

< 15

5.21%

5.23%

0.9364

0.0009

LA anteroposterior diameter

14.3 ± 17.3

17.65 ± 18.56

0.7173701

0.004283972

**Table 2.** Outcome of Death
Cohort outcome statistics
Cohort 1	14,279	1,338	9.37%
Cohort 2	14,279	1,948	13.64%
Measures of association were conducted to evaluate the risk of death between cohort 1 (HCM without T2DM) and cohort 2 (HCM with T2DM) over the 5 years from the index event. Cohort statistics and risk difference, risk ratio, and odds ratio were calculated to interpret the statistical significance of the risk between cohort 1 and cohort 2. T2DM: type 2 diabetes mellitus; HCM: hypertrophic cardiomyopathy; CI: confidence interval.
-4.27%	-5.011%, -3.533%	-11.312	< 0.0001
Risk ratio	95% CI	Odds ratio	95% CI
0.687	0.643, 0.733	0.654	0.608, 0.705

Table 2. Outcome of Death

Cohort outcome statistics

Patients in cohort

Patients with outcome (death)

Risk

Cohort 1

14,279

1,338

9.37%

Cohort 2

14,279

1,948

13.64%

Measures of association

Risk difference

95% CI

z-score

P value

Measures of association were conducted to evaluate the risk of death between cohort 1 (HCM without T2DM) and cohort 2 (HCM with T2DM) over the 5 years from the index event. Cohort statistics and risk difference, risk ratio, and odds ratio were calculated to interpret the statistical significance of the risk between cohort 1 and cohort 2. T2DM: type 2 diabetes mellitus; HCM: hypertrophic cardiomyopathy; CI: confidence interval.

-4.27%

-5.011%, -3.533%

-11.312

< 0.0001

Risk ratio

95% CI

Odds ratio

95% CI

0.687

0.643, 0.733

0.654

0.608, 0.705

**Table 3.** Outcome of New-Onset Heart Failure
Cohort outcome statistics
Cohort 1	10,474	1,295	12.36%
Cohort 2	9,246	1,465	15.85%
Measures of association were conducted to evaluate the risk of new-onset heart failure between cohort 1 (HCM without T2DM) and cohort 2 (HCM with T2DM) over the 5 years from the index event. Cohort statistics and risk difference, risk ratio, and odds ratio were calculated to interpret the statistical significance of the risk between cohort 1 and cohort 2. T2DM: type 2 diabetes mellitus; HCM: hypertrophic cardiomyopathy; CI: confidence interval.
-3.48%	-4.456%, -2.505%	-7.031	< 0.0001
Risk ratio	95% CI	Odds ratio	95% CI
0.780	0.728, 0.836	0.749	0.691, 0.812

Table 3. Outcome of New-Onset Heart Failure

Cohort outcome statistics

Patients in cohort

Patients with outcome (heart failure)

Risk

Cohort 1

10,474

1,295

12.36%

Cohort 2

9,246

1,465

15.85%

Measures of association

Risk difference

95% CI

z-score

P value

Measures of association were conducted to evaluate the risk of new-onset heart failure between cohort 1 (HCM without T2DM) and cohort 2 (HCM with T2DM) over the 5 years from the index event. Cohort statistics and risk difference, risk ratio, and odds ratio were calculated to interpret the statistical significance of the risk between cohort 1 and cohort 2. T2DM: type 2 diabetes mellitus; HCM: hypertrophic cardiomyopathy; CI: confidence interval.

-3.48%

-4.456%, -2.505%

-7.031

< 0.0001

Risk ratio

95% CI

Odds ratio

95% CI

0.780

0.728, 0.836

0.749

0.691, 0.812