title: A propensity-matched study of the association of diabetes mellitus with incident heart failure and mortality among community-dwelling older adults.
abstract: Diabetes mellitus (DM) is a risk factor for incident heart failure (HF) in older adults. However, the extent to which this association is independent of other risk factors remains unclear. Of 5,464 community-dwelling adults ≥65 years old in the Cardiovascular Health Study without baseline HF, 862 had DM (fasting plasma glucose levels ≥126 mg/dl or treatment with insulin or oral hypoglycemic agents). Propensity scores for DM were estimated for each of the 5,464 participants and were used to assemble a cohort of 717 pairs of participants with and without DM who were balanced in 65 baseline characteristics. Incident HF occurred in 31% and 26% of matched participants with and without DM, respectively, during >13 years of follow-up (hazard ratio 1.45 for DM vs no DM, 95% confidence interval [CI] 1.14 to 1.86, p = 0.003). Of the 5,464 participants before matching unadjusted and multivariable-adjusted hazard ratios for incident HF associated with DM were 2.22 (95% CI 1.94 to 2.55, p <0.001) and 1.52 (95% CI 1.30 to 1.78, p <0.001), respectively. All-cause mortality occurred in 57% and 47% of matched participants with and without DM, respectively (hazard ratio 1.35, 95% CI 1.13 to 1.61, p = 0.001). Of matched participants DM-associated hazard ratios for incident peripheral arterial disease, incident acute myocardial infarction, and incident stroke were 2.50 (95% CI 1.45 to 4.32, p = 0.001), 1.37 (95% CI 0.97 to 1.93, p = 0.072), and 1.11 (95% CI 0.81 to 1.51, p = 0.527), respectively. In conclusion, the association of DM with incident HF and all-cause mortality in community-dwelling older adults without HF is independent of major baseline cardiovascular risk factors.
authors.affiliation: University of Alabama at Birmingham, USA.
authors.forename: Brita
authors.initials: B
authors.lastname: Roy
authors.forename: Pushkar P
authors.initials: PP
authors.lastname: Pawar
authors.forename: Ravi V
authors.initials: RV
authors.lastname: Desai
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Marjan
authors.initials: M
authors.lastname: Mujib
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Feller
authors.forename: Fernando
authors.initials: F
authors.lastname: Ovalle
authors.forename: Inmaculada B
authors.initials: IB
authors.lastname: Aban
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Love
authors.forename: Ami E
authors.initials: AE
authors.lastname: Iskandrian
authors.forename: Prakash
authors.initials: P
authors.lastname: Deedwania
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D000368:Aged; D048909:Diabetes Complications / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality*; D006801:Humans; D008297:Male; D057216:Propensity Score; D012111:Residence Characteristics