207-LB: Type 2 Diabetes and Heart Failure: Insights from the DISCOVER Study
Authors: ARNOLD SUZANNE V. , CHEN HUNGTA , CID-RUZAFA JAVIER , FENICI PETER , GOMES MARILIA B. , KHUNTI KAMLESH , LUPORINI SARAIVA GABRIELA , MEDINA JESUS , POCOCK STUART , SADIKOT SHAUKAT M. , SHESTAKOVA MARINA V. , SHIMOMURA IICHIRO , SURMONT FILIP , TANG FENGMING , VORA JITEN , WATADA HIROTAKA , JI LINONG , CHARBONNEL BERNARD , BONNET FABRICE , KOSIBOROD MIKHAIL N. 
Published: June 2019

Background: Heart failure (HF) is one of the most morbid complications of T2D, but the role of T2D in the development of HF has been under-appreciated. We assessed the incidence and prevalence of HF in a global cohort of patients with T2D.
Methods: DISCOVER is a global, observational study of patients with T2D enrolled at initiation of second-line glucose-lowering therapy. Outcomes have been prospectively collected for 2 years.
Results: Among 15,359 patients from 37 countries (mean age 57 y, mean T2D duration 5.6 y, mean HbA1c 8.3%), 290 patients (1.9%) had HF at enrollment (range across countries of 0-9%), of whom 129 (45%) had known coronary artery disease (CAD). Patients with HF were older, had a longer duration of T2D, had a greater prevalence of atherosclerosis, and were less likely to be treated with metformin and thiazolidinediones (Table). Incidence of HF was 0.4% in year 1 and 0.2% in year 2; the prevalence of HF after 2 years was 2.5%. Among incident HF events, 74% were diagnosed in the outpatient setting and 56% occurred in the absence of CAD.
Conclusion: Although HF is not highly prevalent in patients with a relatively short duration of T2D, it is more common with increasing age and longer T2D duration. Most patients with T2D who develop HF do not have clinically evident CAD. These findings highlight the need for greater awareness of HF risk independent of CAD and a deeper understanding of how to prevent and optimally manage HF in patients with T2D.

Disclosure
S.V. Arnold: None. H. Chen: Employee; Self; AstraZeneca. J. Cid-Ruzafa: Employee; Self; Evidera. P. Fenici: Employee; Self; AstraZeneca. M.B. Gomes: Advisory Panel; Self; AstraZeneca. Consultant; Self; Merck KGaA. Research Support; Self; CNPq, FAPERJ. K. Khunti: Advisory Panel; Self; Amgen Inc., AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis, Servier, Takeda Pharmaceutical Company Limited. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis. Speaker’s Bureau; Self; AstraZeneca, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Menarini Group, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi, Servier, Takeda Pharmaceutical Company Limited. G. Luporini Saraiva: Employee; Self; AstraZeneca. J. Medina: Employee; Self; AstraZeneca. S. Pocock: Consultant; Self; AstraZeneca. S.M. Sadikot: Consultant; Self; AstraZeneca. M.V. Shestakova: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Servier. Research Support; Self; Novo Nordisk A/S, Sanofi. I. Shimomura: Advisory Panel; Self; AstraZeneca, Novo Nordisk Pharma Ltd., Sanwa Kagaku Kenkyusho. Consultant; Self; MSD K.K., Novo Nordisk Pharma Ltd., Taisho Pharmaceutical Co., Ltd. Research Support; Self; Astellas Pharma Inc., AstraZeneca, Daiichi Sankyo Company, Limited, Eli Lilly Japan K.K., Kaken Pharmaceutical Co., Ltd., Kowa Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, MSD K.K., Novartis Pharma K.K., Novo Nordisk Pharma Ltd., Shionogi & Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. Speaker’s Bureau; Self; Astellas Pharma Inc., AstraZeneca, Daiichi Sankyo Company, Limited, Eli Lilly Japan K.K., Kowa Pharmaceutical Co., Ltd., Lotte Co., Ltd., Mitsubishi Tanabe Pharma Corporation, MSD K.K., Novartis Pharma K.K., Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi K.K., Sanwa Kagaku Kenkyusho, Taisho Toyama Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. F. Surmont: Employee; Self; AstraZeneca. F. Tang: Employee; Self; Mid America Heart Institute. Research Support; Self; AstraZeneca. J. Vora: Employee; Self; AstraZeneca. Research Support; Self; Abbott, AstraZeneca, Boehringer Ingelheim International GmbH, Bristol-Myers Squibb Company, Eli Lilly and Company, GlaxoSmithKline plc., Merck KGaA, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi, Takeda Pharmaceutical Company Limited. H. Watada: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kissei Pharmaceutical Co., Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Pfizer Inc., Sanofi, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. Speaker’s Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk A/S, Ono Pharmaceutical Co., Ltd., Sanofi, Takeda Pharmaceutical Company Limited, Terumo Medical Corporation. Other Relationship; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Kowa Pharmaceutical Europe Co. Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Ono Pharmaceutical Co., Ltd., Sanwa Chemical Industry Co. Ltd., Takeda Pharmaceutical Company Limited. L. Ji: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Bristol-Myers Squibb Company, Eli Lilly and Company, Merck KGaA, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi, Takeda Pharmaceutical Company Limited. Research Support; Self; AstraZeneca, Bristol-Myers Squibb Company, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Roche Pharma, Sanofi. B. Charbonnel: Consultant; Self; AstraZeneca, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Servier. Speaker’s Bureau; Self; AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Takeda Pharmaceutical Company Limited. F. Bonnet: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Takeda Pharmaceutical Company Limited. M.N. Kosiborod: Consultant; Self; Amgen Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Eisai Co., Ltd., GlaxoSmithKline plc., Glytec, LLC, Intarcia Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novartis AG, Novo Nordisk A/S, Sanofi. Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc.

Funding
AstraZeneca