title: Glycemic status and incident heart failure in elderly without history of diabetes mellitus: the health, aging, and body composition study.
abstract: BACKGROUND
  It is unclear whether measures of glycemic status beyond fasting glucose (FG) levels improve incident heart failure (HF) prediction in patients without history of diabetes mellitus (DM).
  
  
  RESULTS
  The association of measures of glycemic status at baseline (including FG, oral glucose tolerance testing [OGTT], fasting insulin, hemoglobin A(1c) [HbA(1c)] levels, and homeostasis model assessment of insulin resistance [HOMA-IR] and insulin secretion [HOMA-B]) with incident HF, defined as hospitalization for new-onset HF, was evaluated in 2386 elderly participants without history of DM enrolled in the Health, Aging, and Body Composition Study (median age, 73 years; 47.6% men; 62.5% white, 37.5% black) using Cox models. After a median follow-up of 7.2 years, 185 (7.8%) participants developed HF. Incident HF rate was 10.7 cases per 1000 person-years with FG <100mg/dL, 13.1 with FG 100-125 mg/dL, and 26.6 with FG >or=126 mg/dL (P=.002; P=.003 for trend). In adjusted models (for body mass index, age, history of coronary artery disease and smoking, left ventricular hypertrophy, systolic blood pressure and heart rate [HR], and creatinine and albumin levels), FG was the strongest predictor of incident HF (adjusted HR per 10mg/dL, 1.10; 95% CI, 1.02-1.18; P=.009); the addition of OGTT, fasting insulin, HbA(1c), HOMA-IR, or HOMA-B did not improve HF prediction. Results were similar across race and gender. When only HF with left ventricular ejection fraction (LVEF) <or=40% was considered (n=69), FG showed a strong association in adjusted models (HR per 10mg/dL, 1.15; 95% CI, 1.03-1.29; P=.01). In comparison, when only HF with LVEF >40%, was considered (n=71), the association was weaker (HR per 10mg/dL, 1.05; 95% CI; 0.94-1.18; P=.41).
  
  
  CONCLUSIONS
  Fasting glucose is a strong predictor of HF risk in elderly without history of DM. Other glycemic measures provide no incremental prediction information.
authors.affiliation: Emory University, Atlanta, GA, USA.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kalogeropoulos
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Georgiopoulou
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Harris
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Kritchevsky
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Bauer
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Smith
authors.forename: Elsa
authors.initials: E
authors.lastname: Strotmeyer
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.forename: Peter W F
authors.initials: PW
authors.lastname: Wilson
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
mesh_terms: D000368:Aged; D000375:Aging / Q000097:blood*; D001786:Blood Glucose / Q000378:metabolism; D001823:Body Composition / Q000502:physiology*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000097:blood* / Q000453:epidemiology; D005215:Fasting / Q000097:blood / Q000502:physiology; D005260:Female; D038321:Glycemic Index / Q000502:physiology*; D006304:Health Status; D006333:Heart Failure / Q000097:blood* / Q000150:complications / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male
chemical_list: D001786:Blood Glucose
references.citation: Diabetes Care. 2008 Jan;31 Suppl 1:S55-60
references.pmid: 18165338
references.citation: Circulation. 2007 Mar 20;115(11):1371-5
references.pmid: 17339550
references.citation: Diabet Med. 2000 Dec;17(12):835-40
references.pmid: 11168325
references.citation: Circulation. 2002 Apr 16;105(15):1861-70
references.pmid: 11956132
references.citation: N Engl J Med. 2006 Jul 20;355(3):260-9
references.pmid: 16855266
references.citation: J Am Coll Cardiol. 2006 Oct 17;48(8):1548-51
references.pmid: 17045886
references.citation: Circulation. 1997 Jan 21;95(2):313-5
references.pmid: 9008441
references.citation: Diabetologia. 1985 Jul;28(7):412-9
references.pmid: 3899825
references.citation: Diabetes Care. 2003 May;26(5):1333-7
references.pmid: 12716784
references.citation: Diabetes Metab. 2001 Sep;27(4 Pt 1):425-34
references.pmid: 11547216
references.citation: JAMA. 2001 Sep 12;286(10):1195-200
references.pmid: 11559264
references.citation: J Am Coll Cardiol. 2003 Feb 19;41(4):611-7
references.pmid: 12598073
references.citation: Circ Heart Fail. 2008 Jul;1(2):125-33
references.pmid: 19777072
references.citation: Diabetes Care. 1997 Jul;20(7):1183-97
references.pmid: 9203460
references.citation: Am J Epidemiol. 1981 Nov;114(5):697-704
references.pmid: 7304597
references.citation: Eur J Heart Fail. 2007 Oct;9(10):1051-7
references.pmid: 17765010
references.citation: Diabetes Care. 2003 Jan;26 Suppl 1:S5-20
references.pmid: 12502614
references.citation: Heart Fail Rev. 2002 Apr;7(2):149-59
references.pmid: 11988639
references.citation: Diabetes Care. 2001 Sep;24(9):1614-9
references.pmid: 11522708
references.citation: Diabetes Care. 2004 Aug;27(8):1879-84
references.pmid: 15277411
references.citation: JAMA. 2001 May 16;285(19):2486-97
references.pmid: 11368702
references.citation: N Engl J Med. 2002 Aug 1;347(5):305-13
references.pmid: 12151467
references.citation: Am J Physiol Heart Circ Physiol. 2006 Oct;291(4):H1489-506
references.pmid: 16751293
references.citation: Diabetes Care. 2005 Mar;28(3):612-6
references.pmid: 15735197
references.citation: JAMA. 2005 Jul 20;294(3):334-41
references.pmid: 16030278
references.citation: J Am Coll Cardiol. 2008 Jan 15;51(2):93-102
references.pmid: 18191731
references.citation: Diabetes Care. 2003 Aug;26(8):2433-41
references.pmid: 12882875