title: Diabetes, glycemic control, and new-onset heart failure in patients with stable coronary artery disease: data from the heart and soul study.
abstract: OBJECTIVE
  Diabetes is a predictor of both coronary artery disease (CAD) and heart failure. It is unknown to what extent the association between diabetes and heart failure is influenced by other risk factors for heart failure.
  
  
  METHODS
  We evaluated the association of diabetes and A1C with incident heart failure in outpatients with stable CAD and no history of heart failure (average follow-up 4.1 years).
  
  
  RESULTS
  Of 839 participants, 200 had diabetes (23.8%). Compared with patients who did not have diabetes, those with diabetes had an increased risk of heart failure (hazard ratio [HR] 2.17 [95% CI 1.37-3.44]). Adjustment for risk factors for CAD (age, sex, race, smoking, physical inactivity, obesity, blood pressure, and LDL cholesterol), interim myocardial infarction, and myocardial ischemia did not alter the strength of the association between diabetes and heart failure. After inclusion also of other risk factors for heart failure (left ventricular ejection fraction, diastolic dysfunction, and C-reactive protein) and medication use, diabetes remained an independent predictor of heart failure (HR 3.34 [95% CI 1.65-6.76]; P = 0.001). Each 1% increase in A1C concentration was associated with a 36% increased HR of heart failure hospitalization (HR 1.36 [95% CI 1.17-1.58]).
  
  
  CONCLUSIONS
  In patients with stable CAD who are free from heart failure at baseline, diabetes and glycemic control are independent risk factors for new-onset heart failure. The mechanisms by which diabetes and hyperglycemia lead to heart failure deserve further study, as the association is independent of baseline functional assessment of ischemia, systolic and diastolic function, and interim myocardial infarction.
authors.affiliation: Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. j.p.van.melle@thorax.umcg.nl
authors.forename: Joost P
authors.initials: JP
authors.lastname: van Melle
authors.forename: Mariska
authors.initials: M
authors.lastname: Bot
authors.forename: Peter
authors.initials: P
authors.lastname: de Jonge
authors.forename: Rudolf A
authors.initials: RA
authors.lastname: de Boer
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.forename: Mary A
authors.initials: MA
authors.lastname: Whooley
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood / Q000503:physiopathology*; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000209:etiology*; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
references.citation: Diabetes Care. 2009 Jul;32(7):1327-34
references.pmid: 19502545
references.citation: Lancet. 1998 Sep 12;352(9131):837-53
references.pmid: 9742976
references.citation: Eur J Heart Fail. 2007 Oct;9(10):1051-7
references.pmid: 17765010
references.citation: Circulation. 2007 Jun 26;115(25):3213-23
references.pmid: 17592090
references.citation: JAMA. 1979 May 11;241(19):2035-8
references.pmid: 430798
references.citation: J Am Soc Echocardiogr. 2005 Dec;18(12):1440-63
references.pmid: 16376782
references.citation: Am J Cardiol. 1972 Nov 8;30(6):595-602
references.pmid: 4263660
references.citation: Circ Heart Fail. 2009 May;2(3):209-16
references.pmid: 19808342
references.citation: Arch Intern Med. 2008 Aug 11;168(15):1699-704
references.pmid: 18695086
references.citation: Eur J Heart Fail. 2008 Oct;10(10):933-89
references.pmid: 18826876
references.citation: Diabetes Care. 2003 Aug;26(8):2433-41
references.pmid: 12882875
references.citation: Arch Intern Med. 2001 Apr 9;161(7):996-1002
references.pmid: 11295963
references.citation: Circulation. 2007 Mar 20;115(11):1371-5
references.pmid: 17339550
references.citation: JAMA. 2007 Jan 10;297(2):169-76
references.pmid: 17213400
references.citation: Circulation. 1992 Mar;85(3):1026-31
references.pmid: 1537100
references.citation: JAMA. 2003 Jul 9;290(2):215-21
references.pmid: 12851276
references.citation: J Am Coll Cardiol. 2004 Jun 16;43(12):2236-41
references.pmid: 15193686
references.citation: J Am Coll Cardiol. 2000 May;35(6):1628-37
references.pmid: 10807470
references.citation: Diabetologia. 2008 Dec;51(12):2197-204
references.pmid: 18828004
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: Eur J Heart Fail. 2005 Aug;7(5):859-64
references.pmid: 15923138
references.citation: Diabetes Care. 2005 Mar;28(3):612-6
references.pmid: 15735197
references.citation: Am J Med. 2004 Apr 15;116(8):509-16
references.pmid: 15063811
references.citation: J Am Coll Cardiol. 2009 Apr 14;53(15):e1-e90
references.pmid: 19358937
references.citation: J Am Coll Cardiol. 1989 Jul;14(1):49-57
references.pmid: 2661630