Diabetes, glycemic control, and new-onset heart failure in patients with stable coronary artery disease: data from the heart and soul study.
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.
van Melle
Joost P
JP
Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. j.p.van.melle@thorax.umcg.nl
Bot
Mariska
M
de Jonge
Peter
P
de Boer
Rudolf A
RA
van Veldhuisen
Dirk J
DJ
Whooley
Mary A
MA
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
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