Impact of diabetes on outcomes in patients with low and preserved ejection fraction heart failure: an analysis of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme.
OBJECTIVE
To determine whether the risk of adverse cardiovascular (CV) outcomes associated with diabetes differs in patients with low and preserved ejection fraction (EF) heart failure (HF).


RESULTS
We analysed outcomes in the Candesartan in Heart failure-Assessment of Reduction in Mortality and morbidity (CHARM) programme which randomized 7599 patients with symptomatic HF and a broad range of EF. The prevalence of diabetes was 28.3% in patients with preserved EF (>40%) and 28.5% in those with low EF (<or=40%). Diabetes was associated with a greater relative risk of CV death or HF hospitalization in patients with preserved EF [hazard ratio (HR) 2.0 (1.70-2.36)] than in patients with low EF [HR 1.60 (1.44-1.77); interaction test P = 0.0009]. For all-cause mortality, the risk conferred by diabetes was similar in both low and preserved EF groups. The effect of candesartan in reducing CV morbidity and mortality outcomes was not modified by having diabetes at baseline (P = 0.09 test for interaction).


CONCLUSIONS
Diabetes was an independent predictor of CV morbidity and mortality in patients with HF, regardless of EF. The relative risk of CV death or HF hospitalization conferred by diabetes was significantly greater in patients with preserved when compared with those with low EF HF.
MacDonald
Michael R
MR
Glasgow Royal Infirmary, Glasgow, UK.
Petrie
Mark C
MC
Varyani
Fumi
F
Ostergren
Jan
J
Michelson
Eric L
EL
Young
James B
JB
Solomon
Scott D
SD
Granger
Christopher B
CB
Swedberg
Karl
K
Yusuf
Salim
S
Pfeffer
Marc A
MA
McMurray
John J V
JJ
D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D001562:Benzimidazoles / Q000627:therapeutic use; D001713:Biphenyl Compounds; D003925:Diabetic Angiopathies / Q000150:complications / Q000401:mortality*; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008297:Male; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology*; D013777:Tetrazoles / Q000627:therapeutic use; D016896:Treatment Outcome
D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan