A new study sheds light on the link between diabetes and heart valve problems

A large registration research at the University of Gothenburg found that people with diabetes have a significantly higher risk of illness in their left-sided heart valves than people without diabetes. According to the statistical studies, valvular heart disease can be prevented by lowering blood pressure and other risk variables even more than existing treatment targets.

Four heart valves direct blood flow in the proper direction. Because the pressure on the left side of the heart is the highest, valve disease most commonly affects these two valves. This could have two consequences: The valves lose flexibility and may no longer seal or open enough, resulting in regurgitation (backflow), which reduces the heart’s pumping capability. Valve (valvular) illness can produce a variety of symptoms, including difficulty breathing, weariness, dizziness, and, in the worst-case scenario, heart failure.

Clearly increased risk of valve disease
Diabetes, according to animal studies, may aggravate hardness of heart valves and the rings that connect the valves to the heart. This study shows, for the first time at the population level, how distinct the link is between diabetes and an elevated risk of valve disease. Individuals with type 1 and type 2 diabetes are both at a higher risk of getting it, and the risk of calcification in the aortic valve (aortic stenosis) in the latter is 1.62 times greater than in controls without diabetes.

Reduced chance of regurgitation
People with type 2 diabetes, on the other hand, had a comparatively low risk of regurgitation. However, while this finding could be construed as a protective effect, the researchers believe it is most likely negative.

The lower likelihood of primary regurgitation (or backward flow) in type 2 diabetes is also due to the assumed process of hardening and calcification, which is triggered by factors such as elevated blood pressure, impaired blood-sugar metabolism, and obesity-related factors. The hardening of the heart occurs in all of us as we age – even in people who do not have diabetes – but we assume that diabetes accelerates it,” says Aidin Rawshani, the study’s lead author and a researcher at the University of Gothenburg’s Sahlgrenska Academy as well as a doctor at Sahlgrenska University Hospital.

The study is based on register data from over 3.4 million people in Sweden who were followed up on for 20 years. The findings have been published in the peer-reviewed journal Circulation.

Treatment goals that are optimal
Blood sugar, blood pressure, blood lipids, obesity, and kidney function are identified as distinct risk factors for left-sided heart-valve disease in the study. According to the statistical research, it may be helpful if more traditional risk factors were decreased even further when compared to existing healthcare guidelines. However, as the study’s authors explain, the discovery is merely statistical.

“Our findings show that lowering the suggested treatment targets could minimise the incidence of heart valve disease.” However, because this is only a statistical connection, it must be treated with caution. Clinical trials are required to confirm that the effect is as helpful as the statistics indicate,” Rawshani says.

Diabetes and degenerative valve disease
The study also found that diabetics with normal blood sugar, blood pressure, blood fats (lipids), body mass index (BMI), and kidney function (estimated glomerular filtration rate, eGFR) had a persistently high risk of hardening in left-sided valves, while their risk of suction regurgitation was significantly lower. Various sensitivity studies revealed further intriguing findings, such as a significantly increased incidence of degenerative left-sided valve disease among diabetics. This supports the theory that the lower incidence of valve regurgitation found in diabetics is due to a degenerative process in the valve ring.

The study comprises data on over 3.4 million Swedish residents gathered over a 20-year period. There were 36,211 type 1 diabetics and 678,932 type 2 diabetes among them. The information was gathered from four Swedish national registers: the Diabetes Register, the Patient Register, the Cause of Death Register, and the Prescribed Drug Register. SCB provided matched controls as well as access to the Longitudinal Integrated Database for Health Insurance and Labor Market Studies (LISA).