Mingjie Yin,1 Xiaoyu Xu,2 Jie Li,1 Yanan Sun,3 Yanfeng Zhen,3 Shouling Wu,4 Hui Fang1,3 

1Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China; 2Training Base, Tangshan Gongren Hospital, Tangshan, Hebei, People’s Republic of China; 3Second Department of Endocrinology and Metabolism, Tangshan Gongren Hospital, Tangshan, Hebei, People’s Republic of China; 4Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, People’s Republic of China

Correspondence: Hui Fang, Department of Internal Medicine, Hebei Medical University, 361 Zhongshan East Road, Shijiazhuang, Hebei, 050000, People’s Republic of China, Tel +8613831581838, Email fanghui2818@126.com

Background: Heart failure (HF) constitutes a significant global health challenge. The interplay between the dynamics of glucose metabolic status transitions and the progression of HF has been minimally explored.
Objective: We assessed the impact of shifts in glucose metabolic states on the progression from stage A to stage C HF.
Methods: The Kailuan Study is a large-scale prospective cohort study. Based on data from the Kailuan Study, 41,110 stage A HF patients were included and stratified into 6 groups based on alterations in glucose metabolic status: stable normoglycemic, stable pre-diabetes, diabetes, normoglycemic progressing to pre-diabetes, pre-diabetes back to normoglycemic, and normoglycemic/pre-diabetes progressing to diabetes. Utilizing the Cox proportional hazards regression model, we calculated the hazard ratios (HR) and 95% confidence intervals (CI) associated with the transition to stage C HF among patients with stage A HF with different glucose metabolic state transitions.
Results: Our findings indicated a notably elevated risk for the progression to stage C HF within the diabetic group relative to the stable normoglycemic group (HR, 1.87; 95% CI, 1.66 to 2.10). Additionally, an augmented risk for the progression to stage C HF was observed in the normoglycemic/pre-diabetic to diabetic group (HR, 1.38; 95% CI, 1.15 to 1.65).
Conclusion: Both diabetes and normoglycemic/pre-diabetes progressing to diabetes are associated with heightened risks of progressing from stage A to stage C HF. Conversely, the re-establishment of normoglycemic in pre-diabetes is associated with preventing HF progression.

Keywords: glucose metabolic state, diabetes, pre-diabetes, stage A heart failure, stage C heart failure