Type 2 diabetes is associated with clinical progression of aortic stenosis: a nationwide retrospective study in Sweden

Abstract

Abstract Patients with type 2 diabetes mellitus (T2DM) have elevated risk for aortic stenosis (AS). The impact of diabetes on prognosis and clinical progression in AS is not well documented. In this study we try to assess if patients with T2DM and AS have faster clinical progression compared to patients without diabetes. By linkage of nationwide Swedish registries, we identified 16,116 T2DM and AS individuals (cases) and compared them with 31,066 matched comparators (AS without diabetes) from general population concerning clinical progression, defined as progression from AS diagnosis to hospitalization for heart failure, aortic valve replacement, mortality, and composite outcome of these endpoints. Kaplan–Meier curves were used to compare outcomes between cases and comparators and Cox proportional hazards analyses to account for confounders. AS individuals (total 47,182, 16,116 cases and 31,066 comparators) had mean age 71 years. The cases were younger, men predominated (58% versus 53%) and had more comorbidities. During follow-up, cases had faster clinical progression- 11% higher hazard for valve replacement (95% CI 1.04–1.18), 14% higher hazard for heart failure hospitalization (95% CI 1.03–1.26) and 4% higher hazard for composite outcome (95% CI 1.01–1.08), but with no mortality excess (HR1.00, 95%CI 0.97–1.05). Preexisting T2DM seems to be linked to moderately more rapid clinical progression in AS.