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Residual HF risk persists despite achieving current treatment targets, suggesting a role for additional mechanisms beyond conventional risk factors. We sought to prospectively assess HF incidence and independent risk factors in individuals with new-onset diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We used a prospective inception cohort (ANDIS,\n                      <jats:italic>n<\/jats:italic>\n                      =19,892) that included all individuals with newly diagnosed diabetes from southern Sweden between 2008 and 2021. Baseline clinical, biochemical and questionnaire data were linked to the Region Scania Care Database to obtain data on cardiovascular events and to the National Diabetes Registry to gather further data on cardiovascular risk factors that were not collected in the ANDIS study protocol. All-cause HF included all cases of HF regardless of underlying aetiology, whereas non-ischaemic HF was defined as HF occurring in individuals without prior acute myocardial infarction at baseline or during follow-up before the HF diagnosis. Cardiovascular disease incidence was estimated using the Kaplan\u2013Meier method, and the associations with risk factors and incident HF were assessed using Cox proportional hazards regression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median age of the overall population was 62.5 years (IQR 52.6\u201370.3), while the median age among individuals who developed incident all-cause HF was 69.8 years (IQR 62.7\u201376.7). A total of 819 individuals (4.1%) with prevalent HF were excluded. During up to 14 years of follow-up (median 5.0), the cumulative incidence of HF was 4.8%, exceeding that of myocardial infarction (3.0%). No individuals with type 1 diabetes developed HF, but the incidence was similar across those with type 2 diabetes, latent autoimmune diabetes in adults, and secondary diabetes. A lower eGFR and higher HOMA2-IR, were associated with increased risk of all-cause and non-ischaemic HF, independently of the presence of conventional risk factors. Insulin resistance predicted all-cause HF independently of the established SCORE2-Diabetes risk score. The hazard ratio (HR) per 1\u00a0SD increase in HOMA2-IR was highest in the low-risk group (HR 1.89; 95% CI 1.02, 3.48;\n                      <jats:italic>p<\/jats:italic>\n                      =4.3\u00a0\u00d7\u00a010\n                      <jats:sup>\u22122<\/jats:sup>\n                      ), with concordant results observed for non-ischaemic HF.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\/interpretation<\/jats:title>\n                    <jats:p>The HF incidence was high, with approximately 1 in 20 individuals developing HF within 5 years after diagnosis of diabetes other than type 1, highlighting a notably high risk of developing HF soon after diabetes diagnosis. Beyond conventional risk factors, higher HOMA2-IR and lower renal function, but not hyperglycaemia or autoantibodies, were independent risk factors for HF. Measuring HOMA2-IR also provided prognostic information in addition to that provided by the SCORE2-Diabetes risk score, supporting its value in HF risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00125-026-06823-1","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T19:16:46Z","timestamp":1785784606000},"page":"3248-3260","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence and independent risk factors for heart failure in a population-based cohort of 19,892 individuals with newly diagnosed diabetes"],"prefix":"10.1007","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1966-5865","authenticated-orcid":false,"given":"Carl","family":"Lejonberg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0232-0425","authenticated-orcid":false,"given":"Tomasz","family":"Czuba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7101-1290","authenticated-orcid":false,"given":"Louise","family":"Bennet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8809-4544","authenticated-orcid":false,"given":"Daniel E.","family":"Coral","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3263-2718","authenticated-orcid":false,"given":"Oscar O.","family":"Braun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2581-484X","authenticated-orcid":false,"given":"Olle","family":"Melander","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6210-3142","authenticated-orcid":false,"given":"Maria F.","family":"Gomez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6513-2384","authenticated-orcid":false,"given":"Emma","family":"Ahlqvist","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6285-9935","authenticated-orcid":false,"given":"J. 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De-identified data are available upon reasonable request after publication, with approval from the ANDIS steering committee.","order":1,"name":"Ethics","label":"Data availability","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"The ANDIS study was financed by Swedish governmental funding for clinical research (ALF) from Region Sk\u00e5ne, Swedish Research Council project grant numbers 2020-02191 and 2015-2558, infrastructure grant numbers 2010-5983, 2012-5538 and 2014-6395, Linnaeus grant number 349-2006-237, strategic research grant number 2009-1039 (EXODIAB), and by the Swedish Foundation for Strategic Research IRC15-0067 (LUDC-IRC). JGS was supported by grants from the Swedish Heart\u2013Lung Foundation (2023-03332 and 2025-0805), the Swedish Research Council (2021-02273 and 2024-03314), the European Research Council (ERC-STG-2015-679242), Gothenburg University and Sk\u00e5ne University Hospital, by governmental funding for clinical research within the Swedish National Health Service, and by a generous donation from the Knut and Alice Wallenberg Foundation to the Wallenberg Center for Molecular Medicine in Lund. CL was supported by grants from the Thelma Zo\u00e9ga Foundation (2023-0068) and the Birger Segerfalk Foundation (87407). EA was supported by grants from the Swedish Research Council (2020-02191), Swedish governmental funding for clinical research, and the Swedish Heart and Lung Foundation (20241121). MFG received funding from the Swedish Heart\u2013Lung Foundation (20190470), the Swedish Research Council (2018-02837) and the Innovative Medicines Initiative\u00a02 Joint Undertaking under grant agreement number 115974 (BEAt-DKD). This joint undertaking receives support from the European Union\u2019s Horizon 2020 research and innovation programme, and from EFPIA with JDRF. Any dissemination of results reflects only the authors\u2019 views; the joint undertaking is not responsible for any use that may be made of the information contained in this article. DEC is supported by the EFSD and Lilly European Diabetes Research Programme and by a grant from Novo Nordisk A\/S within the LUDC-IRC framework.","order":2,"name":"Ethics","label":"Funding","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"MFG has received financial and non-financial (in-kind) support from Boehringer Ingelheim Pharma GmbH, JDRF International, Eli Lilly, AbbVie, Sanofi-Aventis, Astellas, Novo Nordisk A\/S and Bayer AG, within EU grant H2020-JTI-lMl2-2015-05 (grant agreement number 115974 \u2013 BEAt-DKD). She has also received financial and in-kind support from Novo Nordisk, Pfizer, Follicum, Coegin Pharma, Abcentra, Probi and Johnson & Johnson within a project funded by the Swedish Foundation for Strategic Research on precision medicine in diabetes (LUDC-IRC 15-0067). MFG has also received personal consultancy fees from Lilly and Tribune Therapeutics AB. EA has received research funding from AstraZeneca. The remaining authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.","order":3,"name":"Ethics","label":"Authors\u2019 relationships and activities","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"CL and JGS researched data, contributed to discussion, and wrote the first draft of the manuscript. TC and EA researched data and reviewed and edited the manuscript. LB, DEC, OOB, OM and MFG contributed to discussion and reviewed and edited the manuscript. All authors approved the final version of the manuscript. CL is the guarantor of this work, and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.","order":4,"name":"Ethics","label":"Contribution statement","group":{"name":"EthicsHeading","label":"Ethics"}}]}}