Evidence map›Paper›PMID 34918855›Full record

Trial reportEuropean journal of heart failure2022

Diabetes and pre-diabetes in patients with heart failure and preserved ejection fraction.

Alice M Jackson, Rasmus Rørth, Jiankang Liu, Søren Lund Kristensen, Inder S Anand, Brian L Claggett, John G F Cleland, Vijay K Chopra, Akshay S Desai, Junbo Ge and 23 more

Registry-linked trialOpen access · hybridAbstract readClinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in European journal of heart failure, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01920711 (A Multicenter, Randomized, Double-blind, Parallel Group, Active-controlled Study to Evaluate the Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients), which is not on this map. Cited by 39 papers.

0numbers the graph read from it
0cells of the map it votes in
39citing papers in PubMed
7.5field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01920711 phase3completednot on this map

A Multicenter, Randomized, Double-blind, Parallel Group, Active-controlled Study to Evaluate the Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients (NYHA Class II-IV) With Preserved Ejection Fraction (PARAGON-HF)

TypeinterventionalSponsorNovartis PharmaceuticalsRan2014 to 2019Enrolled4,822ConditionsHeart Failure With Preserved Ejection FractionArmsLCZ696, Valsartan
3 · Its place in the literature

Who cites it

39 citing papers in PubMed, 79 citations in OpenAlex.

  1. Trial
  2. Trial
  3. Trial
  4. Trial
  5. Metabolic syndrome and a broken heart: trust your gut or risk your heart.American journal of physiology. Heart and circulatory physiology · 2026
    Review
  6. Article
  7. Review
  8. Review
  9. Observational
  10. Article
  11. Observational
  12. Observational
  13. Review
  14. Review
  15. Review
  16. 2024 update in heart failure.ESC heart failure · 2025
    Review
  17. Article
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

33 authors at 19 institutions in 14 countries.

Alice M JacksonBHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.ORCID 0000-0002-0364-1271
Rasmus RørthBHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Jiankang LiuCardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
Søren Lund KristensenBHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Inder S AnandUniversity of Minnesota, Minneapolis, MN, USA.
Brian L ClaggettCardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
John G F ClelandRobertson Centre for Biostatistics, University of Glasgow, Glasgow, UK.
Vijay K ChopraMax Super Speciality Hospital, Saket, New Delhi, India.
Akshay S DesaiCardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
Junbo GeShanghai Institute of Cardiovascular Diseases, Shanghai, China.
Jianjian GongNovartis Pharmaceuticals, East Hanover, NJ, USA.
Carolyn S P LamNational Heart Center Singapore and Duke-National University of Singapore, Singapore, Singapore.
Martin P LefkowitzNovartis Pharmaceuticals, East Hanover, NJ, USA.
Aldo P MaggioniNational Association of Hospital Cardiologists Research Center, Florence, Italy.
Felipe MartinezNational University of Cordoba, Cordoba, Argentina.
Milton PackerBaylor University Medical Center, Dallas, TX, USA.
Marc A PfefferCardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
Burkert PieskeDepartment of Internal Medicine and Cardiology, German Center for Cardiovascular Research partner site Berlin, Berlin, Germany.
Margaret M RedfieldMayo Clinic, Rochester, MN, USA.
Adel R RizkalaNovartis Pharmaceuticals, East Hanover, NJ, USA.
Jean L RouleauInstitut de Cardiologie de Montréal, Université de Montréal, Montreal, Canada.
Petar M SeferovićFaculty of Medicine, University of Belgrade, Belgrade, Serbia.
Jasper TrompNational Heart Center Singapore and Duke-National University of Singapore, Singapore, Singapore.
Dirk J Van VeldhuisenDepartment of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Mehmet B YilmazFaculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
Faiez ZannadINSERM Centre d'Investigation Clinic 1433 and Universite de Lorraine, Centre Hospitalier Regional et Universitaire, Nancy, France.
Michael R ZileMedical University of South Carolina and the Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, USA.
Lars KøberHeart Centre, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
Mark C PetrieBHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Pardeep S JhundBHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Scott D SolomonCardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
John J V McMurrayBHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.ORCID 0000-0002-6317-3975
PARAGON-HF Committees and Investigators
Brigham and Women's Hospital · USBritish Heart Foundation · GBCopenhagen University Hospital · DKNovartis (United States) · USUniversity Medical Center Groningen · NLAssociazione Nazionale Medici Cardiologi Ospedalieri · ITBaylor University Medical Center · USDokuz Eylül University · TRGerman Centre for Cardiovascular Research · DEInserm · FRMax Super Speciality Hospital · INMayo Clinic · USMedical University of South Carolina · USMontreal Heart Institute · CAShanghai Institute of Hematology · CNUniversidad Nacional de Córdoba · ARUniversity of Belgrade · RSUniversity of Glasgow · GBUniversity of Minnesota · US

Funding

British Heart Foundation FS/18/14/33330British Heart Foundation RE/18/6/34217
6 · The paper itself

Abstract

aimThere 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-diabetes, in HFpEF. We examined characteristics and outcomes of participants with diabetes or pre-diabetes in PARAGON-HF. METHODS AND

resultsPatients aged ≥50 years with left ventricular ejection fraction ≥45%, structural heart disease and elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) were eligible. Patients were classified according to glycated haemoglobin (HbA1c): (i) normal HbA1c, <6.0%; (ii) pre-diabetes, 6.0%-6.4%; (iii) diabetes, ≥6.5% 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-diabetes. Compared to patients with normal HbA1c, patients with pre-diabetes 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-proBNP concentrations. The risks of the primary composite outcome (rate ratio [RR] 1.59, 95% confidence interval [CI] 1.35-1.88), total HFH (RR 1.67, 95% CI 1.39-2.02) and CV death (hazard ratio [HR] 1.35, 95% CI 1.07-1.71) were higher among patients with diabetes, compared to those with normal HbA1c. Patients with pre-diabetes 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 1.00-1.60) and HFH (HR 1.35, 95% CI 1.03-1.77), but not of CV death (HR 1.02, 95% CI 0.75-1.40). Patients with diabetes treated with insulin had worse outcomes than those not, and those with 'lean diabetes' had similar mortality rates to those with a higher body mass index, but lower rates of HFH.

conclusionPre-diabetes is common in patients with HFpEF and is associated with worse clinical status and greater risk of HFH. CLINICAL

trial registrationClinicalTrials.gov Identifier NCT01920711.

Indexed as

Diabetes MellitusHeart FailurePrediabetic StateHumansMiddle AgedNatriuretic Peptide, BrainPeptide FragmentsPrognosisStroke VolumeVentricular Function, LeftNatriuretic Peptide, BrainPeptide FragmentsDiabetesHeart failureInsulinObesity

Identifiers

PMID34918855
PMCPMC9542636
OpenAlexW4200146289

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.