Lifetime risk of heart failure and trends in incidence rates among individuals with type 2 diabetes between 1995 and 2018

Brian Schwartz, Colin Pierce, Ramachandran S. Vasan, Morten Schou, Michel Ibrahim, Kevin Monahan, Asya Lyass, Morten Malmborg, Gunnar H. Gislason, Lars Køber, Christian Torp-Pedersen, Charlotte Andersson

Research output: Contribution to journalArticlepeer-review


BACKGROUND: There are limited data on the lifetime risk of heart failure (HF) in people with type 2 diabetes and how incidence has changed over time. We estimated the cumulative incidence and incidence rates of HF among Danish adults with type 2 diabetes between 1995 and 2018 using nationwide data. METHODS AND RESULTS: In total, 398 422 patients (49% women) with type 2 diabetes were identified. During follow-up, 36 400 (9%) were diagnosed with HF and 121 459 (30%) were censored due to death. Using the Aalen-Johansen estimators, accounting for the risk of death, the estimated residual lifetime risk of HF at age 50 years was calculated as 24% (95% CI 22%– 27%) in women and 27% (25%–28%) in men. During the observational period, the proportion of patients treated with statins, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, and metformin increased from <30% to >60%. Similarly, the annual incidence rates of HF decreased significantly, with declines being greater in older versus younger individuals (5% versus 2% in age >50 versus ≤50 years, respectively; P<0.0001) and in women versus men (5% versus 4%, P=0.02), but similar in patients with and without IHD (4% versus 4%, P=0.53). CONCLUSIONS: The current lifetime risk of HF in type 2 diabetes approximates 1 in 4 for men and women. Paralleled by an increase in use of evidence-based pharmacotherapy over the past decades, the risk of developing HF has declined across several subgroups and regardless of underlying IHD, suggesting that optimal diabetes treatment can mitigate HF risk.

Original languageEnglish (US)
Article numbere021230
JournalJournal of the American Heart Association
Issue number21
StatePublished - Nov 2 2021
Externally publishedYes


  • Cumulative risk
  • Heart failure
  • Incidence rate
  • Temporal trends
  • Type 2 diabetes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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