The association of fasting glucose levels with congestive heart failure in diabetic adults > or =65 years: the Cardiovascular Health Study.
OBJECTIVE
The purpose of this study was to determine if fasting glucose levels are an independent risk factor for congestive heart failure (CHF) in elderly individuals with diabetes mellitus (DM) with or without coronary heart disease (CHD).


BACKGROUND
Diabetes mellitus and CHF frequently coexist in the elderly. It is not clear whether fasting glucose levels in the setting of DM are a risk factor for incident CHF in the elderly.


METHODS
A cohort of 829 diabetic participants, age > or =65 years, without prevalent CHF, was followed for five to eight years. The Cox proportional hazards modeling was used to determine the risk of CHF by fasting glucose levels. The cohort was categorized by the presence or absence of prevalent CHD.


RESULTS
For a 1 standard deviation (60.6 mg/dl) increase in fasting glucose, the adjusted hazard ratios for incident CHF among participants without CHD at baseline, with or without an incident myocardial infarction (MI) or CHD event on follow-up, was 1.41 (95% confidence interval 1.24 to 1.61; p < 0.0001). Among those with prevalent CHD at baseline, with or without another incident MI or CHD event on follow-up, the corresponding adjusted hazard ratio was 1.27 (95% confidence interval 1.02 to 1.58; p < 0.05).


CONCLUSIONS
Among older adults with DM, elevated fasting glucose levels are a risk factor for incident CHF. The relationship of fasting glucose to CHF differs somewhat by the presence or absence of prevalent CHD.
Barzilay
Joshua I
JI
Kaiser Permanente of Georgia and the Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia, USA. joshua.barzilay@kp.org
Kronmal
Richard A
RA
Gottdiener
John S
JS
Smith
Nicholas L
NL
Burke
Gregory L
GL
Tracy
Russell
R
Savage
Peter J
PJ
Carlson
Michelle
M
D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure / Q000502:physiology; D003327:Coronary Disease / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000378:metabolism* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000378:metabolism* / Q000503:physiopathology; D005215:Fasting / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000378:metabolism* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D016016:Proportional Hazards Models; D012307:Risk Factors; D013223:Statistics as Topic; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology
D015415:Biomarkers; D001786:Blood Glucose