{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T15:12:12Z","timestamp":1791817932899,"version":"4.3.4"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,1,4]],"date-time":"2022-01-04T00:00:00Z","timestamp":1641254400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Heart Fail"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>There is an association between heart failure with preserved ejection fraction (HFpEF) and insulin resistance, but less is known about the diabetic continuum, and in particular about pre\u2010diabetes, in HFpEF. We examined characteristics and outcomes of participants with diabetes or pre\u2010diabetes in PARAGON\u2010HF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Patients aged \u226550\u2009years with left ventricular ejection fraction \u226545%, structural heart disease and elevated N\u2010terminal pro\u2010B\u2010type natriuretic peptide (NT\u2010proBNP) were eligible. Patients were classified according to glycated haemoglobin (HbA1c): (i) normal HbA1c, &lt;6.0%; (ii) pre\u2010diabetes, 6.0%\u20136.4%; (iii) diabetes, \u22656.5% or history of diabetes. The primary outcome was a composite of cardiovascular (CV) death and total heart failure hospitalizations (HFH). Of 4796 patients, 50% had diabetes and 18% had pre\u2010diabetes. Compared to patients with normal HbA1c, patients with pre\u2010diabetes and diabetes more often were obese, had a history of myocardial infarction and had lower Kansas City Cardiomyopathy Questionnaire scores, while patients with diabetes had more clinical evidence of congestion, but similar NT\u2010proBNP concentrations. The risks of the primary composite outcome (rate ratio [RR] 1.59, 95% confidence interval [CI] 1.35\u20131.88), total HFH (RR 1.67, 95% CI 1.39\u20132.02) and CV death (hazard ratio [HR] 1.35, 95% CI 1.07\u20131.71) were higher among patients with diabetes, compared to those with normal HbA1c. Patients with pre\u2010diabetes had a higher risk (which was intermediate between that of patients with diabetes and those with normal HbA1c) of the primary outcome (HR 1.27, 95% CI 1.00\u20131.60) and HFH (HR 1.35, 95% CI 1.03\u20131.77), but not of CV death (HR 1.02, 95% CI 0.75\u20131.40). Patients with diabetes treated with insulin had worse outcomes than those not, and those with \u2018lean diabetes\u2019 had similar mortality rates to those with a higher body mass index, but lower rates of HFH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pre\u2010diabetes is common in patients with HFpEF and is associated with worse clinical status and greater risk of HFH. Clinical Trial Registration: ClinicalTrials.gov Identifier NCT01920711.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.2403","type":"journal-article","created":{"date-parts":[[2021,12,17]],"date-time":"2021-12-17T08:32:50Z","timestamp":1639729970000},"page":"497-509","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":80,"title":["Diabetes and pre\u2010diabetes in patients with heart failure and preserved ejection fraction"],"prefix":"10.1093","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0364-1271","authenticated-orcid":false,"given":"Alice M.","family":"Jackson","sequence":"first","affiliation":[{"name":"BHF Cardiovascular Research Centre University of Glasgow  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasmus","family":"R\u00f8rth","sequence":"additional","affiliation":[{"name":"BHF Cardiovascular Research Centre University of Glasgow  Glasgow UK"},{"name":"Heart Centre, Rigshospitalet Copenhagen University Hospital  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiankang","family":"Liu","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women's Hospital  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00f8ren Lund","family":"Kristensen","sequence":"additional","affiliation":[{"name":"BHF Cardiovascular Research Centre University of Glasgow  Glasgow UK"},{"name":"Heart Centre, Rigshospitalet Copenhagen University Hospital  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inder S.","family":"Anand","sequence":"additional","affiliation":[{"name":"University of Minnesota  Minneapolis MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian L.","family":"Claggett","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women's Hospital  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John G.F.","family":"Cleland","sequence":"additional","affiliation":[{"name":"Robertson Centre for Biostatistics University of Glasgow  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay K.","family":"Chopra","sequence":"additional","affiliation":[{"name":"Max Super Speciality Hospital, Saket  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akshay S.","family":"Desai","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women's Hospital  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junbo","family":"Ge","sequence":"additional","affiliation":[{"name":"Shanghai Institute of Cardiovascular Diseases  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianjian","family":"Gong","sequence":"additional","affiliation":[{"name":"Novartis Pharmaceuticals  East Hanover NJ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn S.P.","family":"Lam","sequence":"additional","affiliation":[{"name":"National Heart Center Singapore and Duke\u2013National University of Singapore  Singapore Singapore"},{"name":"Department of Cardiology, University Medical Center Groningen University of Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin P.","family":"Lefkowitz","sequence":"additional","affiliation":[{"name":"Novartis Pharmaceuticals  East Hanover NJ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aldo P.","family":"Maggioni","sequence":"additional","affiliation":[{"name":"National Association of Hospital Cardiologists Research Center  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe","family":"Martinez","sequence":"additional","affiliation":[{"name":"National University of Cordoba  Cordoba Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milton","family":"Packer","sequence":"additional","affiliation":[{"name":"Baylor University Medical Center  Dallas TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc A.","family":"Pfeffer","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women's Hospital  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burkert","family":"Pieske","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiology German Center for Cardiovascular Research partner site Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret M.","family":"Redfield","sequence":"additional","affiliation":[{"name":"Mayo Clinic  Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adel R.","family":"Rizkala","sequence":"additional","affiliation":[{"name":"Novartis Pharmaceuticals  East Hanover NJ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean L.","family":"Rouleau","sequence":"additional","affiliation":[{"name":"Institut de Cardiologie de Montr\u00e9al Universit\u00e9 de Montr\u00e9al  Montreal Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petar M.","family":"Seferovi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Belgrade  Belgrade Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasper","family":"Tromp","sequence":"additional","affiliation":[{"name":"National Heart Center Singapore and Duke\u2013National University of Singapore  Singapore Singapore"},{"name":"Department of Cardiology, University Medical Center Groningen University of Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk J.","family":"Van Veldhuisen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Groningen University of Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet B.","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Dokuz Eylul University  Izmir Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faiez","family":"Zannad","sequence":"additional","affiliation":[{"name":"INSERM Centre d'Investigation Clinic 1433 and Universite de Lorraine, Centre Hospitalier Regional et Universitaire  Nancy France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Zile","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina and the Ralph H. Johnson Department of Veterans Affairs Medical Center  Charleston SC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"K\u00f8ber","sequence":"additional","affiliation":[{"name":"Heart Centre, Rigshospitalet Copenhagen University Hospital  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark C.","family":"Petrie","sequence":"additional","affiliation":[{"name":"BHF Cardiovascular Research Centre University of Glasgow  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pardeep S.","family":"Jhund","sequence":"additional","affiliation":[{"name":"BHF Cardiovascular Research Centre University of Glasgow  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott D.","family":"Solomon","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women's Hospital  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6317-3975","authenticated-orcid":false,"given":"John J.V.","family":"McMurray","sequence":"additional","affiliation":[{"name":"BHF Cardiovascular Research Centre University of Glasgow  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"PARAGON\u2010HF Committees and Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,1,4]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.4115"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000088845.17586.EC"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(74)90089-7"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehn153"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2261-14-61"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1358"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.13511"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.115.002560"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2017.04.013"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.118.004962"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1908655"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1535"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1146"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.4239\/wjd.v6.i4.613"},{"key":"e_1_2_6_16_1","volume-title":"IDF diabetes atlas","author":"International Diabetes Federation","year":"2019"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/1467-9868.00259"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv134"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10557-017-6754-x"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.005156"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.14490"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-11-0754"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12350-016-0622-0"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1673"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002541"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.726"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2018.11.022"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/1753-0407.13017"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2017.04.026"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.026807"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-2839"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.2337\/db15-0305"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/oby.21418"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa823"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1954"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-1675"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2107038"}],"container-title":["European Journal of Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ejhf.2403","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ejhf.2403","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ejhf.2403","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T12:16:18Z","timestamp":1767701778000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ejhf.2403"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,4]]},"references-count":36,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2022,3]]}},"alternative-id":["10.1002\/ejhf.2403"],"URL":"https:\/\/doi.org\/10.1002\/ejhf.2403","archive":["Portico"],"relation":{},"ISSN":["1388-9842","1879-0844"],"issn-type":[{"value":"1388-9842","type":"print"},{"value":"1879-0844","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,4]]},"assertion":[{"value":"2021-08-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-12-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-01-04","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}