Diabetes and the Risk of Heart Failure Among More Than 60,000 Acute Myocardial Infarction Survivors: A Systematic Review and Meta-Analysis

Diabetes mellitus (DM) has raided its incidence across the last decades. It brings several cardiovascular complications. DM increases acute myocardial infarction (AMI) risk and affects systolic and diastolic function. Several studies have explored the association between DM and AMI complications, like heart failure (HF). Therefore, we synthesized evidence regarding the association between DM and HF among AMI survivors. We performed a systematic review of longitudinal studies that explored the association between DM and HF after AMI. The search was from inception to January 2023 in Pubmed, Scopus and EMBASE. We excluded studies that did not clearly state if HF was new-onset after AMI. We performed a meta-analysis following the randomed-effect model with the inverse variance method. From 4,512 articles, we selected 19 cohort studies (n=60 451) of AMI survivors. Mean age ranged from 55.4 to 77.8 years. More than 60% of patients were male. In comparison with non-diabetics, those AMI survivors with diabetes had higher risk of new-onset heart failure (RR: 1.78, 95%CI: 1.58-2.01) (attached figure). In addition, left ventricular ejection fraction (%) was lower among diabetic survivors (MD: -1.57, 95%CI: -2.69 to -0.45). As exploratory analysis, AMI in the anterior wall was the most frequent without significant differences between DM and non-DM (pooled prevalence in DM: 54% vs. non-DM: 49%). Diabetes was associated with higher risk of mortality (RR: 2.09, 95% CI: 1.52-2.88) and reinfarction (RR: 1.59, 95% CI: 1.22-2.08) after an AMI event. All studies had low risk of bias. After AMI, DM patients have a strong risk of HF. Comprehensive clinical follow-up should be done among this population.