Recognizing Racial, Ethnic Differences in Diabetic Cardiomyopathy, with Jose Lopez, MD

Diabetic cardiomyopathy (DbCM) increases risk of overt heart failure in individuals with diabetes mellitus, but emerging research suggests racial and ethnic differences may cause some patients to experience more severe DbCM risk features than others.

The topic was discussed during a session at the 9th Annual Heart in Diabetes Conference in Philadelphia, Pennsylvania, by Jose Lopez, MD, a cardiovascular disease fellow at the University of Miami Miller School of Medicine/JFK Medical Center, during which he reviewed findings from the ARISE-HF trial assessing the efficacy of an aldose reductase inhibitor for exercise capacity preservation in people with DbCM. Specifically, Lopez discussed racial and ethnic differences in baseline characteristics, echocardiographic parameters, and functional capacity in the ARISE-HF cohort.

“I think we need to be aware that diabetic cardiomyopathy exists, that you can have heart muscle disease from diabetes itself and all the metabolic changes it produces independently of ischemic heart disease,” Lopez explained to HCPLive, noting that although the main trial results did not show a statistically significant difference, he believes this was largely attributable to the trial design and that there may still be benefit with these medications.

In ARISE-HF, among a cohort of 691 individuals with DbCM who were randomized to receive placebo or ascending doses of AT-001 twice daily, peak Vo2 fell in the placebo-treated patients by −0.31 mL/kg/min by 15 months (P = .005 compared to baseline), whereas in those receiving high-dose AT-001, peak Vo2 fell by −0.01 mL/kg/min (P = .21); the difference in peak Vo2 between placebo and high-dose AT-001 was 0.30 (P = .19).1

In prespecified subgroup analyses among those not receiving sodium-glucose cotransporter 2 inhibitors or glucagon-like peptide-1 receptor agonists at baseline, the difference between peak Vo2 in placebo vs high-dose AT-001 at 15 months was 0.62 mL/kg/min (P = .04; interaction P = .10).1

Further analysis stratified by race and ethnicity revealed Black and Hispanic patients had lower use of diabetes mellitus treatments and Black patients had poorer baseline ventricular function and more impaired global longitudinal strain. Health status was preserved, as determined by Kansas City Cardiomyopathy Questionnaire scores, but reduced exercise capacity was present as evidenced by reduced Physical Activity Scale for the Elderly (PASE) scores.2

When stratified by race and ethnicity and compared with the entire cohort, Black patients had poorer health status, more reduced physical activity, and a greater impairment in exercise capacity during cardiopulmonary exercise testing, whereas Hispanic patients also displayed compromised cardiopulmonary exercise testing functional capacity. In contrast, White patients demonstrated higher physical activity and functional capacity.2

Lopez cautions that the racial differences observed in ARISE-HF should be interpreted as being related to social determinants of health rather than biological factors, noting many of these disparities can be traced back to ones that already exist in patients with diabetes.

“The most important thing to get actionable change would be policy interventions, because there are a lot of things that clinicians can do, but there are a lot of others that are out of their hands,” Lopez explained, describing the importance of things like having an area to walk and access to high-quality, healthy food, as well as medicine.

Editors’ note: Lopez has no relevant disclosures to report.

References

1. Lopez J, Liu Y, Butler J, et al. Racial Differences in Diabetic Cardiomyopathy: The ARISE-HF Trial. JACC. https://doi.org/10.1016/j.jacc.2024.04.053

2. Januzzi J, Butler J, Del Prato S, et al. Randomized Trial of a Selective Aldose Reductase Inhibitor in Patients With Diabetic Cardiomyopathy. JACC. https://doi.org/10.1016/j.jacc.2024.03.380