title: Prognostic Impact of Diabetes Mellitus in Chronic Heart Failure According to Presence of Ischemic Heart Disease – With Special Reference to Nephropathy.
abstract: BACKGROUND
  It is unclear whether the prognostic impact of diabetes mellitus (DM) in chronic heart failure (CHF) is influenced by ischemic heart disease (IHD) and/or nephropathy.
  
  
  RESULTS
  We enrolled 4,065 consecutive patients with stage C/D CHF (mean age, 69.0 years; 68.7% male) in the CHART-2 Study (n=10,219). We defined DM as current history of DM treatment or HbA1c ≥6.5% (National Glycohemoglobin Standardization Program [NGSP]), and nephropathy as urine albumin:creatinine ratio ≥30 mg/g or urine dipstick test ≥(±) at enrollment. Impacts of DM and nephropathy on the composite of death, myocardial infarction, stroke, and HF admission were examined. Among the 4,065 patients, 1,448 (35.6%) had DM, while IHD and nephropathy were also noted in 1,644 (40.4%) and in 1,549 (38.1%), respectively. During the median follow-up of 2.88 years, 1,025 (25.2%) reached the composite endpoint. On multivariate Cox regression, DM was significantly associated with the composite endpoint in all patients (HR, 1.17; P=0.02), and in those with IHD (HR, 1.38; P=0.004), but not in those without IHD (HR, 1.12; P=0.22; P for interaction=0.12). Furthermore, when the patients were stratified by nephropathy, DM was associated with worse prognosis only in the IHD patients with nephropathy.
  
  
  CONCLUSIONS
  The prognostic impact of DM was more evident in patients with IHD than in those without IHD, particularly when complicated with nephropathy.
authors.affiliation: Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Miura
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sakata
authors.forename: Satoshi
authors.initials: S
authors.lastname: Miyata
authors.forename: Kotaro
authors.initials: K
authors.lastname: Nochioka
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takada
authors.forename: Soichiro
authors.initials: S
authors.lastname: Tadaki
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Ushigome
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamauchi
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Sato
authors.forename: Takeo
authors.initials: T
authors.lastname: Onose
authors.forename: Kanako
authors.initials: K
authors.lastname: Tsuji
authors.forename: Ruri
authors.initials: R
authors.lastname: Abe
authors.forename: Jun
authors.initials: J
authors.lastname: Takahashi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimokawa
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000097:blood / Q000401:mortality; D002908:Chronic Disease; D048909:Diabetes Complications / Q000097:blood / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000401:mortality; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000401:mortality; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000401:mortality; D015996:Survival Rate