New light on the link between diabetes and heart valve disease

June 10, 2022 — Individuals with diabetes showed an increased risk of disease in the left heart valves compared to non-diabetic controls, according to a comprehensive registry study at the University of Gothenburg. Statistical analyzes also indicate that valvular heart disease can be prevented by lowering blood pressure and reducing other risk factors even more than current treatment goals.

The four valves of the heart make the blood go in the right direction. Because the pressure is higher on the left side of the heart, valve disease often affects these two valves. This may have two effects: the valves lose their elasticity and may not close or open adequately, and regurgitation (reverse flow) occurs, impairing the heart’s pumping ability. Valve (valvular) disease can cause many problems, such as difficulty breathing, fatigue, dizziness and, in the worst case, heart failure.

Significantly increased risk of valve disease

Other research, in animal models, has shown that diabetes may worsen the stiffness of the valves in the heart and in the loops that connect the valves to the heart. At the population level, this study shows for the first time how different the relationship between diabetes and increased risk of valve disease is. Both individuals with type 1 and type 2 diabetes are at risk of developing it, and for the latter, the risk of developing calcification of the aortic valve (aortic stenosis) is 1.62 times higher than that of people without diabetes.

Less risk of regurgitation

On the other hand, a relatively low risk of reflux was found in people with type 2 diabetes. However, although this finding can be interpreted as a protective effect, the researchers say it is probably not positive.

“The reduced risk of primary regurgitation (or reverse flow) in type 2 diabetes is also due to a putative sclerosis and calcification process initiated, for example, by hypertension, impaired glycemic metabolism, and obesity-related factors. In life, the process of hardening of the heart occurs in all of us – even in individuals without diabetes – but we assume that diabetes accelerates its onset,” an academic and physician at Sahlgrenska University Hospital.

The study is based on registration data on just over 3.4 million people in Sweden, who were followed over a 20-year period. The results were published in the scientific journal Rotation.

Optimal treatment goals

The study identifies blood sugar, blood pressure, blood lipids, obesity and kidney function as specific factors that influence the risk of developing left heart valve disease. Statistical analysis shows that it may be beneficial if more traditional risk factors are further reduced, compared to current health care guidelines. However, the result is purely statistical, as the researchers behind the study emphasized.

“Our results indicate that the risk of heart valve disease can be reduced if the recommended treatment goals are lowered. But this result should be interpreted with caution as it is no longer a statistical correlation so far. Clinical trials are necessary to verify that the effect is really beneficial as it indicates,” said Al-Roshani. statistics.

Degenerative valve disease and diabetes

The study also showed that diabetics whose blood sugar, blood pressure, blood lipids (lipids), body mass index (BMI), and kidney function (estimated glomerular filtration rate, eGFR) were within the therapeutic target range were consistently at risk for sclerosis. in left valves, while the risk of suction reflux was significantly lower, compared to controls. Various sensitivity analyzes yielded more significant findings, such as a higher risk of degenerative left valve disease among diabetic patients. This supports the hypothesis that it is a degenerative process in the valve annulus that contributes to the reduced risk of valve regurgitation observed in patients with diabetes.

The study includes data, collected over a 20-year period, on just over 3.4 million people in Sweden. Among them, 36,211 were type 1 and 678,932 were type 2 diabetics. Data were collected from four national Swedish registries: diabetes registry, patient registry, cause of death registry, and prescription drug registry. Statistics Sweden (SCB) provided identical controls and access to the Integrated Longitudinal Database for Health Insurance and Labor Market Studies (LISA).

More study results: compared with individuals without diabetes,

  • People with type 2 diabetes have a 1.62 times risk of developing aortic stenosis (hardening of the aortic valve), and a 2.28 times higher risk of developing mitral valve stenosis (hardening of the mitral valve).
    • People with type 1 diabetes have a 2.59 times higher risk of developing aortic stenosis, and an 11.43 times higher risk of developing mitral valve stenosis.
    • People with type 1 diabetes have a 1.38 times greater risk of developing mitral valve regurgitation.
    • For people with type 2 diabetes, the risk of regurgitation is slightly lower. The risk of primary regurgitation in the aorta and mitral valve is 19 and 5 percent lower, respectively.
    • Even with optimal control of risk factors, patients with type 2 diabetes had a 1.34 times higher risk of aortic stenosis and 1.95 times higher risk of developing mitral valve stenosis, while the risks of aortic and mitral regurgitation were 33 and 18 percent lower, respectively.
    • Type 2 diabetics have a 2.27 times higher risk of developing degenerative mitral valve stenosis, while type 1 diabetics have a 21.72 times higher risk. Systolic blood pressure and BMI show the clearest association with risk with left valve disease.
    • For people with type 1 diabetes and optimal control of risk factors, the risk of developing aortic stenosis is 2.01 times higher and the risk of developing mitral stenosis 3.47 times.

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