{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T18:31:58Z","timestamp":1794508318722,"version":"4.9.1"},"reference-count":54,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,4,5]],"date-time":"2025-04-05T00:00:00Z","timestamp":1743811200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,4,5]],"date-time":"2025-04-05T00:00:00Z","timestamp":1743811200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cardiovasc Diabetol"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Most patients with heart failure with preserved ejection fraction (HFpEF) have a metabolic phenotype in which comorbidities including diabetes mellitus play an important role. Factors related to impaired glucose metabolism, such as kidney disease, may contribute to adverse clinical events. Albuminuria is an early marker of kidney disease. We assessed the prevalence of impaired glucose metabolism and albuminuria in HFpEF over time, and evaluated its prognostic implications.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Consecutive patients referred to our outpatient clinic and diagnosed with HFpEF between March 2015\u2013November 2023 were included in this study. Patients with type 1 diabetes were excluded. Patients were stratified according to baseline glucose metabolism status (DM\u2009+\u2009for prediabetes and diabetes, or DM\u2212) and albuminuria status (ALB+\u2009or ALB\u2212 for albuminuria\u2009&gt;\u20093.0\u00a0mg\/mmol and normoalbuminuria, respectively). The primary outcome was a composite of HF hospitalizations (HFH) and all-cause mortality, and was analysed using multivariable-adjusted Cox-regression models.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Among 332 patients with HFpEF (median age 77\u00a0years; 67% female), 121 (36.4%) were classified as DM\u2212\/ALB\u2212, 106 (31.9%) as DM+\u2009\/ALB\u2212, 44 (13.3%) as DM\u2212\/ALB+, and 61 (18.4%) as DM+\u2009\/ALB+. Both baseline DM and ALB were independently associated with the primary outcome after approximately 3\u00a0years: adjusted hazard ratio (aHR) 1.93; 95% confidence interval (CI) 1.25\u20132.97 and 1.58; 95%CI 1.04\u20132.41, respectively. Patients in the DM+\u2009\/ALB+\u2009group showed the highest risk (aHR 2.85; 95%CI 1.57\u20135.15). After one year, DM\/ALB status was re-evaluated in 250 (75%) patients. New DM+\u2009and ALB+\u2009incidence was 3.9% and 22%in those at risk, respectively. Patients particularly changed ALB groups compared to baseline (n\u2009=\u200963, 25.2%); 27 (10.8%) patients recovered from albuminuria. At 3\u00a0years follow-up, the primary outcome mainly occurred in patients who consistently showed albuminuria (27.1%) or who recovered from albuminuria (22.2%), and less so in patients who developed albuminuria after one year (13.9%) or who remained free of albuminuria (8.6%) (<jats:italic>p<\/jats:italic>\u2009=\u20090.008).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>DM and albuminuria are prevalent in HFpEF at baseline, and re-evaluation one year later still reveals new diagnoses. Both factors are independently associated with adverse outcomes. Albuminuria at any time point remains predictive of adverse outcomes in HFpEF.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical abstract<\/jats:title>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Research insights<\/jats:title>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>What is currently known about this topic?<\/jats:title>\n            <jats:p>Diabetes mellitus is an important cardiovascular risk factor in patients with HFpEF, contributing to disease progression and worse outcomes. Albuminuria is a prognostic marker in heart failure patients and more prevalent in patients with diabetes<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>What is the key research question?<\/jats:title>\n            <jats:p>What is prevalence of impaired glucose metabolism and albuminuria in HFpEF over time and how does this translate to prognosis?<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>What is new?<\/jats:title>\n            <jats:p>Both DM and albuminuria each independently associated with worse prognosis in HFpEF. Screening 1 year after HFpEF diagnosis yielded incidence rates of 3.9% and 10.8% for DM and prediabetes, respectively, and 22% for albuminuria. Albuminuria at any time point appeared prognostic in HFpEF, also when albuminuria recovered<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>How might this study influence clinical practice?<\/jats:title>\n            <jats:p>Intermittent screening of HFpEF patients for abnormal glucose metabolism and albuminuria is warranted to optimize risk management<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12933-025-02708-6","type":"journal-article","created":{"date-parts":[[2025,4,5]],"date-time":"2025-04-05T11:52:17Z","timestamp":1743853937000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Temporal prevalence and prognostic impact of diabetes mellitus and albuminuria in heart failure with preserved ejection fraction"],"prefix":"10.1186","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6547-7008","authenticated-orcid":false,"given":"Nousjka P. A.","family":"Vranken","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0225-6937","authenticated-orcid":false,"given":"Xinyu","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2164-4011","authenticated-orcid":false,"given":"Heleen","family":"Bouman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3408-6511","authenticated-orcid":false,"given":"Sanne G. J.","family":"Mourmans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0763-7551","authenticated-orcid":false,"given":"Anouk","family":"Achten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3448-5531","authenticated-orcid":false,"given":"Arantxa","family":"Barandiar\u00e1n Aizpurua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4356-8566","authenticated-orcid":false,"given":"Hans-Peter","family":"Brunner-La Rocca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5457-3010","authenticated-orcid":false,"given":"Christian","family":"Knackstedt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6864-0296","authenticated-orcid":false,"given":"Vanessa P. M.","family":"van Empel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9369-3453","authenticated-orcid":false,"given":"Jerremy","family":"Weerts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,5]]},"reference":[{"key":"2708_CR1","doi-asserted-by":"publisher","first-page":"3272","DOI":"10.1093\/cvr\/cvac013","volume":"118","author":"G Savarese","year":"2022","unstructured":"Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res. 2022;118:3272\u201387.","journal-title":"Cardiovasc Res"},{"key":"2708_CR2","doi-asserted-by":"publisher","first-page":"1551","DOI":"10.1002\/ejhf.1902","volume":"22","author":"M Packer","year":"2020","unstructured":"Packer M, Lam CSP, Lund LH, Maurer MS, Borlaug BA. Characterization of the inflammatory-metabolic phenotype of heart failure with a preserved ejection fraction: a hypothesis to explain influence of sex on the evolution and potential treatment of the disease. Eur J Heart Fail. 2020;22:1551\u201367.","journal-title":"Eur J Heart Fail"},{"key":"2708_CR3","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1007\/s10557-017-6754-x","volume":"31","author":"SL Kristensen","year":"2017","unstructured":"Kristensen SL, Jhund PS, Lee MMY, K\u00f8ber L, Solomon SD, Granger CB, Yusuf S, Pfeffer MA, Swedberg K, McMurray JJV. CHARM investigators and committees. Prevalence of prediabetes and undiagnosed diabetes in patients with HFpEF and HFrEF and associated clinical outcomes. Cardiovasc Drugs Ther. 2017;31:545\u20139.","journal-title":"Cardiovasc Drugs Ther"},{"key":"2708_CR4","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1177\/1479164118794619","volume":"15","author":"I Johansson","year":"2018","unstructured":"Johansson I, Dahlstr\u00f6m U, Edner M, N\u00e4sman P, Ryd\u00e9n L, Norhammar A. Type 2 diabetes and heart failure: characteristics and prognosis in preserved, mid-range and reduced ventricular function. Diab Vasc Dis Res. 2018;15:494\u2013503.","journal-title":"Diab Vasc Dis Res"},{"key":"2708_CR5","doi-asserted-by":"publisher","first-page":"1450","DOI":"10.1136\/hrt.2007.128769","volume":"94","author":"C Tribouilloy","year":"2008","unstructured":"Tribouilloy C, Rusinaru D, Mahjoub H, Tarti\u00e8re J-M, Kesri-Tarti\u00e8re L, Godard S, Peltier M. Prognostic impact of diabetes mellitus in patients with heart failure and preserved ejection fraction: a prospective five-year study. Heart Br Card Soc. 2008;94:1450\u20135.","journal-title":"Heart Br Card Soc"},{"key":"2708_CR6","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.ecl.2017.10.001","volume":"47","author":"B Brannick","year":"2018","unstructured":"Brannick B, Dagogo-Jack S. Prediabetes and cardiovascular disease: pathophysiology and interventions for prevention and risk reduction. Endocrinol Metab Clin North Am. 2018;47:33\u201350.","journal-title":"Endocrinol Metab Clin North Am"},{"key":"2708_CR7","doi-asserted-by":"publisher","first-page":"1310","DOI":"10.1016\/j.jacc.2009.10.060","volume":"55","author":"ES Ford","year":"2010","unstructured":"Ford ES, Zhao G, Li C. Pre-diabetes and the risk for cardiovascular disease: a systematic review of the evidence. J Am Coll Cardiol. 2010;55:1310\u20137.","journal-title":"J Am Coll Cardiol"},{"key":"2708_CR8","doi-asserted-by":"publisher","first-page":"150","DOI":"10.2337\/dc17-0755","volume":"41","author":"PB Sandesara","year":"2018","unstructured":"Sandesara PB, O\u2019Neal WT, Kelli HM, Samman-Tahhan A, Hammadah M, Quyyumi AA, Sperling LS. The prognostic significance of diabetes and microvascular complications in patients with heart failure with preserved ejection fraction. Diabetes Care. 2018;41:150\u20135.","journal-title":"Diabetes Care"},{"key":"2708_CR9","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1016\/j.jacc.2022.10.028","volume":"81","author":"MS Khan","year":"2023","unstructured":"Khan MS, Shahid I, Anker SD, Fonarow GC, Fudim M, Hall ME, Hernandez A, Morris AA, Shafi T, Weir MR, Zannad F, Bakris GL, Butler J. Albuminuria and heart failure: JACC state-of-the-art review. J Am Coll Cardiol. 2023;81:270\u201382.","journal-title":"J Am Coll Cardiol"},{"key":"2708_CR10","doi-asserted-by":"publisher","first-page":"1178","DOI":"10.1097\/HJH.0000000000001674","volume":"36","author":"RJH Martens","year":"2018","unstructured":"Martens RJH, Houben AJHM, Kooman JP, Berendschot TTJM, Dagnelie PC, van der Kallen CJH, Kroon AA, Leunissen KML, van der Sande FM, Schaper NC, Schouten JSAG, Schram MT, Sep SJS, S\u00f6rensen BM, Henry RMA, Stehouwer CDA. Microvascular endothelial dysfunction is associated with albuminuria: the Maastricht study. J Hypertens. 2018;36:1178\u201387.","journal-title":"J Hypertens"},{"key":"2708_CR11","doi-asserted-by":"publisher","first-page":"278","DOI":"10.3390\/biom12020278","volume":"12","author":"J Weerts","year":"2022","unstructured":"Weerts J, Mourmans SG, Barandiar\u00e1n Aizpurua A, Schroen BL, Knackstedt C, Eringa E, Houben AJ, van Empel VP. The role of systemic microvascular dysfunction in heart failure with preserved ejection fraction. Biomolecules. 2022;12:278.","journal-title":"Biomolecules"},{"key":"2708_CR12","doi-asserted-by":"publisher","first-page":"1992","DOI":"10.1093\/cvr\/cvaa334","volume":"117","author":"M Volpe","year":"2021","unstructured":"Volpe M, Gallo G. Cardiometabolic phenotype of heart failure with preserved ejection fraction as a target of sodium\u2013glucose co-transporter 2 inhibitors and glucagon-like peptide receptor agonists. Cardiovasc Res. 2021;117:1992\u20134.","journal-title":"Cardiovasc Res"},{"key":"2708_CR13","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.1111\/dom.13652","volume":"21","author":"DSH Bell","year":"2019","unstructured":"Bell DSH, Goncalves E. Heart failure in the patient with diabetes: epidemiology, aetiology, prognosis, therapy and the effect of glucose-lowering medications. Diabetes Obes Metab. 2019;21:1277\u201390.","journal-title":"Diabetes Obes Metab"},{"key":"2708_CR14","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1016\/S0140-6736(22)01429-5","volume":"400","author":"M Vaduganathan","year":"2022","unstructured":"Vaduganathan M, Docherty KF, Claggett BL, Jhund PS, de Boer RA, Hernandez AF, Inzucchi SE, Kosiborod MN, Lam CSP, Martinez F, Shah SJ, Desai AS, McMurray JJV, Solomon SD. SGLT-2 inhibitors in patients with heart failure: a comprehensive meta-analysis of five randomised controlled trials. Lancet Lond Engl. 2022;400:757\u201367.","journal-title":"Lancet Lond Engl"},{"key":"2708_CR15","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1056\/NEJMoa2403347","volume":"391","author":"V Perkovic","year":"2024","unstructured":"Perkovic V, Tuttle KR, Rossing P, Mahaffey KW, Mann JFE, Bakris G, Baeres FMM, Idorn T, Bosch-Traberg H, Lausvig NL, Pratley R. FLOW trial committees and investigators. Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes. N Engl J Med. 2024;391:109\u201321.","journal-title":"N Engl J Med"},{"key":"2708_CR16","doi-asserted-by":"publisher","first-page":"1814","DOI":"10.1016\/j.jchf.2024.07.006","volume":"12","author":"R Patel","year":"2024","unstructured":"Patel R, Wadid M, Makwana B, Kumar A, Khadke S, Bhatti A, Banker A, Husami Z, Labib S, Venesy D, Fonarow G, Kosiborod M, Al-Kindi S, Bhatt DL, Dani S, Nohria A, Butler J, Ganatra S. GLP-1 receptor agonists among patients with overweight or obesity, diabetes, and HFpEF on SGLT2 inhibitors. JACC Heart Fail. 2024;12:1814\u201326.","journal-title":"JACC Heart Fail"},{"key":"2708_CR17","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.1002\/ehf2.13204","volume":"8","author":"A Barandiaran Aizpurua","year":"2021","unstructured":"Barandiaran Aizpurua A, Sanders-van Wijk S, Brunner-La Rocca H-P, Henkens MT, Weerts J, Spanjers MH, Knackstedt C, van Empel VP. Iron deficiency impacts prognosis but less exercise capacity in heart failure with preserved ejection fraction. ESC Heart Fail. 2021;8:1304\u201313.","journal-title":"ESC Heart Fail"},{"key":"2708_CR18","doi-asserted-by":"publisher","first-page":"1463","DOI":"10.1002\/ehf2.13833","volume":"9","author":"MTHM Henkens","year":"2022","unstructured":"Henkens MTHM, Weerts J, Verdonschot JAJ, Raafs AG, Stroeks S, Sikking MA, Amin H, Mourmans SGJ, Geraeds CBG, Sanders-van Wijk S, Barandiar\u00e1n Aizpurua A, Uszko-Lencer NHMK, Krapels IPC, Wolffs PFG, Brunner HG, van Leeuwen REW, Verhesen W, Schalla SM, van Stipdonk AWM, Knackstedt C, Li X, Abdul Hamid MA, van Paassen P, Hazebroek MR, Vernooy K, Brunner-La Rocca H-P, van Empel VPM, Heymans SRB. Improving diagnosis and risk stratification across the ejection fraction spectrum: the Maastricht cardiomyopathy registry. ESC Heart Fail. 2022;9:1463\u201370.","journal-title":"ESC Heart Fail"},{"issue":"37","key":"2708_CR19","first-page":"2129","volume":"2016","author":"Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, Gonz\u00e1lez-Juanatey JR, Harjola V-P, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, Meer P van der, ESC Scientific Document Group","year":"2016","unstructured":"Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, Gonz\u00e1lez-Juanatey JR, Harjola V-P, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, Meer P van der, ESC Scientific Document Group. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European society of cardiology (ESC)Developed with the special contribution of the heart failure association (HFA) of the ESC. Eur Heart J. 2016;2016(37):2129\u2013200.","journal-title":"Eur Heart J"},{"issue":"42","key":"2708_CR20","first-page":"3599","volume":"2021","author":"McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, B\u00f6hm M, Burri H, Butler J, \u010celutkien\u0117 J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, ESC Scientific Document Group","year":"2021","unstructured":"McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, B\u00f6hm M, Burri H, Butler J, \u010celutkien\u0117 J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, ESC Scientific Document Group. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;2021(42):3599\u2013726.","journal-title":"Eur Heart J"},{"key":"2708_CR21","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1161\/CIRCHEARTFAILURE.109.932996","volume":"4","author":"M Komajda","year":"2011","unstructured":"Komajda M, Carson PE, Hetzel S, McKelvie R, McMurray J, Ptaszynska A, Zile MR, Demets D, Massie BM. Factors associated with outcome in heart failure with preserved ejection fraction: findings from the Irbesartan in heart failure with preserved ejection fraction study (I-PRESERVE). Circ Heart Fail. 2011;4:27\u201335.","journal-title":"Circ Heart Fail"},{"key":"2708_CR22","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1093\/ehjci\/jeab222","volume":"23","author":"J Weerts","year":"2022","unstructured":"Weerts J, Barandiar\u00e1n Aizpurua A, Henkens MT, Lyon A, van Mourik MJ, van Gemert MR, Raafs A, Sanders-van Wijk S, Bay\u00e9s-Gen\u00eds A, Heymans SR. The prognostic impact of mechanical atrial dysfunction and atrial fibrillation in heart failure with preserved ejection fraction. Eur Heart J-Cardiovasc Imaging. 2022;23:74\u201384.","journal-title":"Eur Heart J-Cardiovasc Imaging"},{"key":"2708_CR23","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-19425-7","volume-title":"Regression modeling strategies: with applications to linear models, logistic and ordinal regression, and survival analysis","author":"FE Harrell","year":"2015","unstructured":"Harrell FE. Regression modeling strategies: with applications to linear models, logistic and ordinal regression, and survival analysis. Cham: Springer International Publishing; 2015."},{"key":"2708_CR24","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1186\/s12933-023-02041-w","volume":"22","author":"R Zheng","year":"2023","unstructured":"Zheng R, Qian S, Shi Y, Lou C, Xu H, Pan J. Association between triglyceride-glucose index and in-hospital mortality in critically ill patients with sepsis: analysis of the MIMIC-IV database. Cardiovasc Diabetol. 2023;22:307.","journal-title":"Cardiovasc Diabetol"},{"key":"2708_CR25","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.118.005288","volume":"11","author":"S Selvaraj","year":"2018","unstructured":"Selvaraj S, Claggett B, Shah SJ, Anand I, Rouleau JL, O\u2019Meara E, Desai AS, Lewis EF, Pitt B, Sweitzer NK, Fang JC, Pfeffer MA, Solomon SD. Prognostic value of albuminuria and influence of spironolactone in heart failure with preserved ejection fraction. Circ Heart Fail. 2018;11: e005288.","journal-title":"Circ Heart Fail"},{"key":"2708_CR26","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1016\/j.jchf.2014.05.016","volume":"2","author":"DH Katz","year":"2014","unstructured":"Katz DH, Burns JA, Aguilar FG, Beussink L, Shah SJ. Albuminuria is independently associated with cardiac remodeling, abnormal right and left ventricular function, and worse outcomes in heart failure with preserved ejection fraction. JACC Heart Fail. 2014;2:586\u201396.","journal-title":"JACC Heart Fail"},{"key":"2708_CR27","volume":"13","author":"O Mgbemena","year":"2021","unstructured":"Mgbemena O, Zhang Y, Velarde G. Role of diabetes mellitus in heart failure with preserved ejection fraction: a review article. Cureus. 2021;13: e19398.","journal-title":"Cureus"},{"key":"2708_CR28","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1093\/cvr\/cvac049","volume":"119","author":"RJ Phang","year":"2023","unstructured":"Phang RJ, Ritchie RH, Hausenloy DJ, Lees JG, Lim SY. Cellular interplay between cardiomyocytes and non-myocytes in diabetic cardiomyopathy. Cardiovasc Res. 2023;119:668\u201390.","journal-title":"Cardiovasc Res"},{"key":"2708_CR29","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1016\/j.jacc.2018.11.033","volume":"73","author":"K McHugh","year":"2019","unstructured":"McHugh K, DeVore AD, Wu J, Matsouaka RA, Fonarow GC, Heidenreich PA, Yancy CW, Green JB, Altman N, Hernandez AF. Heart failure with preserved ejection fraction and diabetes: JACC state-of-the-art review. J Am Coll Cardiol. 2019;73:602\u201311.","journal-title":"J Am Coll Cardiol"},{"key":"2708_CR30","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/s12933-022-01509-5","volume":"21","author":"TK Son","year":"2022","unstructured":"Son TK, Toan NH, Thang N, Le Trong TH, Tien HA, Thuy NH, Van Minh H, Valensi P. Prediabetes and insulin resistance in a population of patients with heart failure and reduced or preserved ejection fraction but without diabetes, overweight or hypertension. Cardiovasc Diabetol. 2022;21:75.","journal-title":"Cardiovasc Diabetol"},{"key":"2708_CR31","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1002\/ejhf.2403","volume":"24","author":"AM Jackson","year":"2022","unstructured":"Jackson AM, R\u00f8rth R, Liu J, Kristensen SL, Anand IS, Claggett BL, Cleland JGF, Chopra VK, Desai AS, Ge J, Gong J, Lam CSP, Lefkowitz MP, Maggioni AP, Martinez F, Packer M, Pfeffer MA, Pieske B, Redfield MM, Rizkala AR, Rouleau JL, Seferovi\u0107 PM, Tromp J, Van Veldhuisen DJ, Yilmaz MB, Zannad F, Zile MR, K\u00f8ber L, Petrie MC, Jhund PS, Solomon SD, McMurray JJV. PARAGON-HF committees and investigators. Diabetes and pre-diabetes in patients with heart failure and preserved ejection fraction. Eur J Heart Fail. 2022;24:497\u2013509.","journal-title":"Eur J Heart Fail"},{"key":"2708_CR32","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1001\/jama.286.4.421","volume":"286","author":"HC Gerstein","year":"2001","unstructured":"Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B, Hall\u00e9 JP, Young J, Rashkow A, Joyce C, Nawaz S, Yusuf S. HOPE study investigators. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA. 2001;286:421\u20136.","journal-title":"JAMA"},{"key":"2708_CR33","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1016\/j.ekir.2023.11.004","volume":"9","author":"M Yamanouchi","year":"2024","unstructured":"Yamanouchi M, Sawa N, Toyama T, Shimizu M, Oshima M, Yoshimura Y, Sugimoto H, Kurihara S, Oba Y, Ikuma D, Mizuno H, Sekine A, Suwabe T, Hoshino J, Ubara Y, Hara S, Furuichi K, Wada T. Trajectory of GFR decline and fluctuation in albuminuria leading to end-stage kidney disease in patients with biopsy-confirmed diabetic kidney disease. Kidney Int Rep. 2024;9:323\u201333.","journal-title":"Kidney Int Rep"},{"key":"2708_CR34","doi-asserted-by":"publisher","first-page":"581","DOI":"10.2215\/CJN.03190906","volume":"2","author":"MR Weir","year":"2007","unstructured":"Weir MR. Microalbuminuria and cardiovascular disease. Clin J Am Soc Nephrol CJASN. 2007;2:581\u201390.","journal-title":"Clin J Am Soc Nephrol CJASN"},{"key":"2708_CR35","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/j.jacc.2013.02.092","volume":"62","author":"WJ Paulus","year":"2013","unstructured":"Paulus WJ, Tsch\u00f6pe C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013;62:263\u201371.","journal-title":"J Am Coll Cardiol"},{"key":"2708_CR36","first-page":"10","volume":"18","author":"PE de Jong","year":"2003","unstructured":"de Jong PE, Hillege HL, Pinto-Sietsma SJ, de Zeeuw D. Screening for microalbuminuria in the general population: a tool to detect subjects at risk for progressive renal failure in an early phase? Nephrol Dial Transpl Off Publ Eur Dial Transpl Assoc Eur Ren Assoc. 2003;18:10\u20133.","journal-title":"Nephrol Dial Transpl Off Publ Eur Dial Transpl Assoc Eur Ren Assoc"},{"issue":"78","key":"2708_CR37","first-page":"1042","volume":"2021","author":"J-I Shin","year":"1979","unstructured":"Shin J-I, Chang AR, Grams ME, Coresh J, Ballew SH, Surapaneni A, Matsushita K, Bilo HJG, Carrero JJ, Chodick G, Daratha KB, Jassal SK, Nadkarni GN, Nelson RG, Nowak C, Stempniewicz N, Sumida K, Traynor JP, Woodward M, Sang Y, Gansevoort RT. CKD prognosis consortium albuminuria testing in hypertension and diabetes: an individual-participant data meta-analysis in a global consortium. Hypertens Dallas Tex. 1979;2021(78):1042\u201352.","journal-title":"Hypertens Dallas Tex"},{"key":"2708_CR38","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1093\/eurheartj\/ehac528","volume":"44","author":"EM Boorsma","year":"2023","unstructured":"Boorsma EM, Ter Maaten JM, Damman K, van Essen BJ, Zannad F, van Veldhuisen DJ, Samani NJ, Dickstein K, Metra M, Filippatos G, Lang CC, Ng L, Anker SD, Cleland JG, Pellicori P, Gansevoort RT, Heerspink HJL, Voors AA, Emmens JE. Albuminuria as a marker of systemic congestion in patients with heart failure. Eur Heart J. 2023;44:368\u201380.","journal-title":"Eur Heart J"},{"key":"2708_CR39","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1016\/S0140-6736(09)61378-7","volume":"374","author":"CE Jackson","year":"2009","unstructured":"Jackson CE, Solomon SD, Gerstein HC, Zetterstrand S, Olofsson B, Michelson EL, Granger CB, Swedberg K, Pfeffer MA, Yusuf S, McMurray JJV. CHARM investigators and committees. Albuminuria in chronic heart failure: prevalence and prognostic importance. Lancet Lond Engl. 2009;374:543\u201350.","journal-title":"Lancet Lond Engl"},{"key":"2708_CR40","doi-asserted-by":"publisher","first-page":"1475","DOI":"10.1056\/NEJMoa2407107","volume":"391","author":"SD Solomon","year":"2024","unstructured":"Solomon SD, McMurray JJV, Vaduganathan M, Claggett B, Jhund PS, Desai AS, Henderson AD, Lam CSP, Pitt B, Senni M, Shah SJ, Voors AA, Zannad F, Abidin IZ, Alcocer-Gamba MA, Atherton JJ, Bauersachs J, Chang-Sheng M, Chiang C-E, Chioncel O, Chopra V, Comin-Colet J, Filippatos G, Fonseca C, Gajos G, Goland S, Goncalvesova E, Kang S, Katova T, Kosiborod MN, Latkovskis G. Finerenone in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2024;391:1475\u201385.","journal-title":"N Engl J Med"},{"key":"2708_CR41","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.jacc.2024.10.091","volume":"85","author":"FR Mc Causland","year":"2025","unstructured":"Mc Causland FR, Vaduganathan M, Claggett BL, Kulac IJ, Desai AS, Jhund PS, Henderson AD, Brinker M, Perkins R, Scheerer MF, Schloemer P, Lam CSP, Senni M, Shah SJ, Voors AA, Zannad F, Pitt B, McMurray JJV, Solomon SD. Finerenone and kidney outcomes in patients with heart failure: the FINEARTS-HF trial. J Am Coll Cardiol. 2025;85:159\u201368.","journal-title":"J Am Coll Cardiol"},{"key":"2708_CR42","doi-asserted-by":"publisher","first-page":"4592","DOI":"10.1093\/eurheartj\/ehaa650","volume":"41","author":"AS Levey","year":"2020","unstructured":"Levey AS, Eckardt K-U, Dorman NM, Christiansen SL, Cheung M, Jadoul M, Winkelmayer WC. Nomenclature for kidney function and disease-executive summary and glossary from a kidney disease: improving global outcomes (KDIGO) consensus conference. Eur Heart J. 2020;41:4592\u20138.","journal-title":"Eur Heart J"},{"key":"2708_CR43","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1053\/j.ajkd.2011.02.391","volume":"58","author":"S Blecker","year":"2011","unstructured":"Blecker S, Matsushita K, K\u00f6ttgen A, Loehr LR, Bertoni AG, Boulware LE, Coresh J. High-Normal albuminuria and risk of heart failure in the community. Am J Kidney Dis Off J Natl Kidney Found. 2011;58:47\u201355.","journal-title":"Am J Kidney Dis Off J Natl Kidney Found"},{"key":"2708_CR44","doi-asserted-by":"publisher","first-page":"1383","DOI":"10.1056\/NEJMoa1313731","volume":"370","author":"B Pitt","year":"2014","unstructured":"Pitt B, Pfeffer MA, Assmann SF, Boineau R, Anand IS, Claggett B, Clausell N, Desai AS, Diaz R, Fleg JL, Gordeev I, Harty B, Heitner JF, Kenwood CT, Lewis EF, O\u2019Meara E, Probstfield JL, Shaburishvili T, Shah SJ, Solomon SD, Sweitzer NK, Yang S, McKinlay SM. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370:1383\u201392.","journal-title":"N Engl J Med"},{"key":"2708_CR45","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1159\/000517020","volume":"52","author":"H Trujillo","year":"2021","unstructured":"Trujillo H, Caravaca-Font\u00e1n F, Caro J, Morales E, Praga M. The forgotten antiproteinuric properties of diuretics. Am J Nephrol. 2021;52:435\u201349.","journal-title":"Am J Nephrol"},{"key":"2708_CR46","unstructured":"McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, B\u00f6hm M, Burri H, Butler J, \u010celutkien\u0117 J, Chioncel O, Cleland JGF, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Skibelund AK, ESC Scientific Document Group. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2023:ehad195."},{"key":"2708_CR47","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1016\/S2213-8587(24)00102-5","volume":"12","author":"MS Usman","year":"2024","unstructured":"Usman MS, Bhatt DL, Hameed I, Anker SD, Cheng AYY, Hernandez AF, Jones WS, Khan MS, Petrie MC, Udell JA, Friede T, Butler J. Effect of SGLT2 inhibitors on heart failure outcomes and cardiovascular death across the cardiometabolic disease spectrum: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2024;12:447\u201361.","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2708_CR48","doi-asserted-by":"publisher","first-page":"1334","DOI":"10.1097\/HJH.0000000000002050","volume":"37","author":"A Piperidou","year":"2019","unstructured":"Piperidou A, Sarafidis P, Boutou A, Thomopoulos C, Loutradis C, Alexandrou ME, Tsapas A, Karagiannis A. The effect of SGLT-2 inhibitors on albuminuria and proteinuria in diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. J Hypertens. 2019;37:1334\u201343.","journal-title":"J Hypertens"},{"key":"2708_CR49","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1007\/s00125-017-4509-7","volume":"61","author":"L Uthman","year":"2018","unstructured":"Uthman L, Baartscheer A, Bleijlevens B, Schumacher CA, Fiolet JWT, Koeman A, Jancev M, Hollmann MW, Weber NC, Coronel R, Zuurbier CJ. Class effects of SGLT2 inhibitors in mouse cardiomyocytes and hearts: inhibition of Na+\/H+ exchanger, lowering of cytosolic Na+ and vasodilation. Diabetologia. 2018;61:722\u20136.","journal-title":"Diabetologia"},{"key":"2708_CR50","doi-asserted-by":"publisher","first-page":"1088","DOI":"10.1016\/j.kint.2020.12.013","volume":"99","author":"RP Juni","year":"2021","unstructured":"Juni RP, Al-Shama R, Kuster DWD, Velden J, Hamer HM, Vervloet MG, Eringa EC, Koolwijk P, Hinsbergh VWM. Empagliflozin restores chronic kidney disease\u2013induced impairment of endothelial regulation of cardiomyocyte relaxation and contraction. Kidney Int. 2021;99:1088\u2013101.","journal-title":"Kidney Int"},{"key":"2708_CR51","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1124\/jpet.116.235069","volume":"359","author":"E Benetti","year":"2016","unstructured":"Benetti E, Mastrocola R, Vitarelli G, Cutrin JC, Nigro D, Chiazza F, Mayoux E, Collino M, Fantozzi R. Empagliflozin protects against diet-induced NLRP-3 inflammasome activation and lipid accumulation. J Pharmacol Exp Ther. 2016;359:45\u201353.","journal-title":"J Pharmacol Exp Ther"},{"key":"2708_CR52","doi-asserted-by":"publisher","first-page":"2108","DOI":"10.1007\/s00125-018-4670-7","volume":"61","author":"S Verma","year":"2018","unstructured":"Verma S, McMurray JJV. SGLT2 inhibitors and mechanisms of cardiovascular benefit: a state-of-the-art review. Diabetologia. 2018;61:2108\u201317.","journal-title":"Diabetologia"},{"key":"2708_CR53","doi-asserted-by":"publisher","first-page":"1180","DOI":"10.1111\/dom.12572","volume":"17","author":"R Chilton","year":"2015","unstructured":"Chilton R, Tikkanen I, Cannon CP, Crowe S, Woerle HJ, Broedl UC, Johansen OE. Effects of empagliflozin on blood pressure and markers of arterial stiffness and vascular resistance in patients with type 2 diabetes. Diabetes Obes Metab. 2015;17:1180\u201393.","journal-title":"Diabetes Obes Metab"},{"key":"2708_CR54","doi-asserted-by":"publisher","first-page":"732","DOI":"10.1016\/j.cmet.2021.02.016","volume":"33","author":"T Sen","year":"2021","unstructured":"Sen T, Heerspink HJL. A kidney perspective on the mechanism of action of sodium glucose co-transporter 2 inhibitors. Cell Metab. 2021;33:732\u20139.","journal-title":"Cell Metab"}],"container-title":["Cardiovascular Diabetology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12933-025-02708-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12933-025-02708-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12933-025-02708-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,6]],"date-time":"2025-04-06T21:05:38Z","timestamp":1743973538000},"score":1,"resource":{"primary":{"URL":"https:\/\/cardiab.biomedcentral.com\/articles\/10.1186\/s12933-025-02708-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,5]]},"references-count":54,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["2708"],"URL":"https:\/\/doi.org\/10.1186\/s12933-025-02708-6","relation":{},"ISSN":["1475-2840"],"issn-type":[{"value":"1475-2840","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,5]]},"assertion":[{"value":"20 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 April 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Institutional Review Board and performed according to the principles of the Declaration of Helsinki. All patients provided written informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"A.A. reports grants and personal fees from Pfizer and Alnylam, outside the submitted work paid to the institution. H.P.B.L.R. reports grants, personal fees and non-financial support from Roche Diagnostics, personal fees from Novartis, personal fees from AstraZeneca, grants and personal fees from Vifor, personal fees from Boehringer-Ingelheim, outside the submitted work. C.K. has received speaker honoraria from Pfizer, BMS, paid to the Maastricht University Medical Center, and consulting fees from Bayer, Pfizer, Novartis, BMS, and Alnylam paid to the Maastricht University Medical Center. V.v.E. reports grants and personal fees from Bayer, grants from Roche Diagnostics, grants from Vifor, personal fees from Novartis, personal fees from AstraZeneca, personal fees from Merck, personal fees from Janssen, outside the submitted work. J.W. reports grants from Corvia Medical, CSL Vifor, and Boehringer Ingelheim, outside the submitted work. The other authors declare that they have no conflict of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"156"}}