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Abstract 17134: Biomarker-Based Risk Prediction of Incident Heart Failure Over 5 Years in Prediabetes and Diabetes: Pooled Analysis Across 3 US Community Cohorts


 Introduction:
 While patients with dysglycemia and known CV disease face high risks of transition to HF and benefit from risk reduction strategies (such as SGLT-2 inhibitors), identification of at-risk patients without CV disease for allocation of primary prevention interventions is less clear. Biomarkers may improve risk stratification and inform targeted application of preventive strategies.
 
 
 Methods:
 Participants free of CV disease from 3 cohort studies (Atherosclerosis Risk in Communities Study, Dallas Heart Study, and Multiethnic Study of Atherosclerosis) were included. A biomarker score was developed incorporating hs-cTnT ≥ 6 ng/L, NT-proBNP ≥ 100 pg/mL, hs-CRP ≥ 3 mg/L, and LVH by electrocardiogram. Among participants with dysglycemia, 5-year risks of incident HF and the number of HF events potentially prevented per 1,000 participants treated with an SGLT-2 inhibitor for 5-years were estimated.
 
 
 Results:
 Among 6,799 participants with prediabetes (66.8%) and diabetes (33.3%), there were 891 incident HF events over median follow-up of 17 years. The biomarker score alone demonstrated good discrimination and calibration for predicting 5-year HF risk [C-statistic 0.76 (0.71 to 0.81), calibration p value = 0.62]. Among those with dysglycemia, 5-year risk of HF in the very low (score = 0) and low biomarker score groups (score = 1) were similar to that observed among individuals with euglycemia (0.74%). The 5-year risk of HF increased in a graded fashion across increasing biomarker score groups. For every 1,000 participants with diabetes treated with an SGLT-2 inhibitor for 5-years, the estimated number of HF events prevented was estimated to be 4, 5, 14, and 41, respectively for individuals with scores of 0, 1, 2, and 3-4.
 
 
 Conclusions:
 Among adults with prediabetes and diabetes, a biomarker score can inform HF risk stratification. Individuals with diabetes and high biomarker scores face the highest risk of HF and are expected to benefit the most from SGLT-2 inhibitors.
 
 
 
