Diabetes, Subclinical Myocardial Injury or Stress, and Risk of Heart Failure Subtypes: The Jackson Heart Study

OBJECTIVE To assess the extent to which the concomitant presence of subclinical myocardial injury or stress and diabetes affects the risk of heart failure (HF) subtypes. RESEARCH DESIGN AND METHODS The Jackson Heart Study included Black adults, categorized based on diabetes status, high-sensitivity cardiac troponin I (hs-cTnI), and brain natriuretic peptide (BNP) levels. Subclinical myocardial injury was defined as hs-cTnI ≥4 ng/L in women and ≥6 ng/L in men, and subclinical myocardial stress as BNP ≥35 pg/mL. The study outcomes included incident HF, HF with preserved ejection fraction (HFpEF), and HF with reduced ejection fraction (HFrEF). RESULTS Among 3,484 participants (mean age 54.6 years, 63.2% women, 22.3% with diabetes, 26.4% with subclinical myocardial injury, 9.4% with subclinical myocardial stress), 306 developed HF (151 HFpEF and 139 HFrEF) over 12 years. Compared with individuals with no diabetes and no subclinical myocardial injury at recruitment, participants with diabetes and subclinical myocardial injury had a higher HF risk (hazard ratio [HR] 3.84, 95% CI 2.60–5.66), HFpEF (HR 3.68, 95% CI 2.13–6.36), and HFrEF (HR 4.26, 95% CI 2.40–7.53). The HRs associated with the presence of diabetes and subclinical myocardial stress versus their joint absence were 4.03 (95% CI 2.50–6.51), 5.71 (95% CI 3.11–10.47), and 2.13 (95% CI 0.88–5.17) for HF, HFpEF, and HFrEF, respectively. There was no significant diabetes status and cardiac biomarkers interaction. CONCLUSIONS Both diabetes and subclinical myocardial damage significantly increase the risk of all HF types among Black individuals.