title: Impact of Diabetes Mellitus on Hospitalization for Heart Failure, Cardiovascular Events, and Death: Outcomes at 4 Years From the Reduction of Atherothrombosis for Continued Health (REACH) Registry.
abstract: BACKGROUND
  Despite the known association of diabetes mellitus with cardiovascular events, there are few contemporary data on the long-term outcomes from international cohorts of patients with diabetes mellitus. We sought to describe cardiovascular outcomes at 4 years and to identify predictors of these events in patients with diabetes mellitus.
  
  
  RESULTS
  The Reduction of Atherothrombosis for Continued Health (REACH) registry is an international registry of patients at high risk of atherothrombosis or established atherothrombosis. Four-year event rates in patients with diabetes mellitus were determined with the corrected group prognosis method. Of the 45 227 patients in the REACH registry who had follow-up at 4 years, 43.6% (n=19 699) had diabetes mellitus at baseline. The overall risk and hazard ratio (HR) of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke were greater in patients with diabetes compared with patients without diabetes (16.5% versus 13.1%; adjusted HR, 1.27; 95% confidence interval [CI] 1.19-1.35). There was also an increase in both cardiovascular death (8.9% versus 6.0%; adjusted HR, 1.38; 95% CI, 1.26-1.52) and overall death (14.3% versus 9.9%; adjusted HR, 1.40; 95% CI, 1.30-1.51). Diabetes mellitus was associated with a 33% greater risk of hospitalization for heart failure (9.4% versus 5.9%; adjusted odds ratio, 1.33; 95% CI, 1.18-1.50). In patients with diabetes mellitus, heart failure at baseline was independently associated with cardiovascular death (adjusted HR, 2.45; 95% CI, 2.17-2.77; P<0.001) and hospitalization for heart failure (adjusted odds ratio, 4.72; 95% CI, 4.22-5.29; P<0.001).
  
  
  CONCLUSIONS
  Diabetes mellitus substantially increases the risk of death, ischemic events, and heart failure. Patients with both diabetes mellitus and heart failure are at particularly elevated risk of cardiovascular death, highlighting the need for additional therapies in this high-risk population.
authors.affiliation: From TIMI Study Group, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (M.A.C., J.K., K.I., D.L.B.); French Alliance for Cardiovascular Clinical Trials, Département Hospitalo-Universitaire, Fibrosis, Inflammation, Remodeling, Université Paris-Diderot, Sorbonne Paris-Cité, Laboratory of Vascular Translational Science, INSERM U-1148, Hôpital Bichat, Hopitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); National Heart Lung Institute, Imperial College, Royal Brompton Hospital, London, UK (P.G.S.); University of North Carolina, Chapel Hill (S.C.S.); University of Michigan, Ann Arbor (K.E.); Duke Clinical Research Institute, Durham, NC (E.M.O.); Tokai University, Kanagawa, Japan (S.G.); and Emory University and the Atlanta VA Medical Center, Atlanta, GA (P.W.F.W.).
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Cavender
authors.affiliation: From TIMI Study Group, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (M.A.C., J.K., K.I., D.L.B.); French Alliance for Cardiovascular Clinical Trials, Département Hospitalo-Universitaire, Fibrosis, Inflammation, Remodeling, Université Paris-Diderot, Sorbonne Paris-Cité, Laboratory of Vascular Translational Science, INSERM U-1148, Hôpital Bichat, Hopitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); National Heart Lung Institute, Imperial College, Royal Brompton Hospital, London, UK (P.G.S.); University of North Carolina, Chapel Hill (S.C.S.); University of Michigan, Ann Arbor (K.E.); Duke Clinical Research Institute, Durham, NC (E.M.O.); Tokai University, Kanagawa, Japan (S.G.); and Emory University and the Atlanta VA Medical Center, Atlanta, GA (P.W.F.W.).
authors.forename: Ph Gabriel
authors.initials: PG
authors.lastname: Steg
authors.affiliation: From TIMI Study Group, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (M.A.C., J.K., K.I., D.L.B.); French Alliance for Cardiovascular Clinical Trials, Département Hospitalo-Universitaire, Fibrosis, Inflammation, Remodeling, Université Paris-Diderot, Sorbonne Paris-Cité, Laboratory of Vascular Translational Science, INSERM U-1148, Hôpital Bichat, Hopitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); National Heart Lung Institute, Imperial College, Royal Brompton Hospital, London, UK (P.G.S.); University of North Carolina, Chapel Hill (S.C.S.); University of Michigan, Ann Arbor (K.E.); Duke Clinical Research Institute, Durham, NC (E.M.O.); Tokai University, Kanagawa, Japan (S.G.); and Emory University and the Atlanta VA Medical Center, Atlanta, GA (P.W.F.W.).
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Smith
authors.affiliation: From TIMI Study Group, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (M.A.C., J.K., K.I., D.L.B.); French Alliance for Cardiovascular Clinical Trials, Département Hospitalo-Universitaire, Fibrosis, Inflammation, Remodeling, Université Paris-Diderot, Sorbonne Paris-Cité, Laboratory of Vascular Translational Science, INSERM U-1148, Hôpital Bichat, Hopitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); National Heart Lung Institute, Imperial College, Royal Brompton Hospital, London, UK (P.G.S.); University of North Carolina, Chapel Hill (S.C.S.); University of Michigan, Ann Arbor (K.E.); Duke Clinical Research Institute, Durham, NC (E.M.O.); Tokai University, Kanagawa, Japan (S.G.); and Emory University and the Atlanta VA Medical Center, Atlanta, GA (P.W.F.W.).
authors.forename: Kim
authors.initials: K
authors.lastname: Eagle
authors.affiliation: From TIMI Study Group, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (M.A.C., J.K., K.I., D.L.B.); French Alliance for Cardiovascular Clinical Trials, Département Hospitalo-Universitaire, Fibrosis, Inflammation, Remodeling, Université Paris-Diderot, Sorbonne Paris-Cité, Laboratory of Vascular Translational Science, INSERM U-1148, Hôpital Bichat, Hopitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); National Heart Lung Institute, Imperial College, Royal Brompton Hospital, London, UK (P.G.S.); University of North Carolina, Chapel Hill (S.C.S.); University of Michigan, Ann Arbor (K.E.); Duke Clinical Research Institute, Durham, NC (E.M.O.); Tokai University, Kanagawa, Japan (S.G.); and Emory University and the Atlanta VA Medical Center, Atlanta, GA (P.W.F.W.).
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
authors.affiliation: From TIMI Study Group, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (M.A.C., J.K., K.I., D.L.B.); French Alliance for Cardiovascular Clinical Trials, Département Hospitalo-Universitaire, Fibrosis, Inflammation, Remodeling, Université Paris-Diderot, Sorbonne Paris-Cité, Laboratory of Vascular Translational Science, INSERM U-1148, Hôpital Bichat, Hopitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); National Heart Lung Institute, Imperial College, Royal Brompton Hospital, London, UK (P.G.S.); University of North Carolina, Chapel Hill (S.C.S.); University of Michigan, Ann Arbor (K.E.); Duke Clinical Research Institute, Durham, NC (E.M.O.); Tokai University, Kanagawa, Japan (S.G.); and Emory University and the Atlanta VA Medical Center, Atlanta, GA (P.W.F.W.).
authors.forename: Shinya
authors.initials: S
authors.lastname: Goto
authors.affiliation: From TIMI Study Group, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (M.A.C., J.K., K.I., D.L.B.); French Alliance for Cardiovascular Clinical Trials, Département Hospitalo-Universitaire, Fibrosis, Inflammation, Remodeling, Université Paris-Diderot, Sorbonne Paris-Cité, Laboratory of Vascular Translational Science, INSERM U-1148, Hôpital Bichat, Hopitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); National Heart Lung Institute, Imperial College, Royal Brompton Hospital, London, UK (P.G.S.); University of North Carolina, Chapel Hill (S.C.S.); University of Michigan, Ann Arbor (K.E.); Duke Clinical Research Institute, Durham, NC (E.M.O.); Tokai University, Kanagawa, Japan (S.G.); and Emory University and the Atlanta VA Medical Center, Atlanta, GA (P.W.F.W.).
authors.forename: Julia
authors.initials: J
authors.lastname: Kuder
authors.affiliation: From TIMI Study Group, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (M.A.C., J.K., K.I., D.L.B.); French Alliance for Cardiovascular Clinical Trials, Département Hospitalo-Universitaire, Fibrosis, Inflammation, Remodeling, Université Paris-Diderot, Sorbonne Paris-Cité, Laboratory of Vascular Translational Science, INSERM U-1148, Hôpital Bichat, Hopitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); National Heart Lung Institute, Imperial College, Royal Brompton Hospital, London, UK (P.G.S.); University of North Carolina, Chapel Hill (S.C.S.); University of Michigan, Ann Arbor (K.E.); Duke Clinical Research Institute, Durham, NC (E.M.O.); Tokai University, Kanagawa, Japan (S.G.); and Emory University and the Atlanta VA Medical Center, Atlanta, GA (P.W.F.W.).
authors.forename: Kyungah
authors.initials: K
authors.lastname: Im
authors.affiliation: From TIMI Study Group, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (M.A.C., J.K., K.I., D.L.B.); French Alliance for Cardiovascular Clinical Trials, Département Hospitalo-Universitaire, Fibrosis, Inflammation, Remodeling, Université Paris-Diderot, Sorbonne Paris-Cité, Laboratory of Vascular Translational Science, INSERM U-1148, Hôpital Bichat, Hopitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); National Heart Lung Institute, Imperial College, Royal Brompton Hospital, London, UK (P.G.S.); University of North Carolina, Chapel Hill (S.C.S.); University of Michigan, Ann Arbor (K.E.); Duke Clinical Research Institute, Durham, NC (E.M.O.); Tokai University, Kanagawa, Japan (S.G.); and Emory University and the Atlanta VA Medical Center, Atlanta, GA (P.W.F.W.).
authors.forename: Peter W F
authors.initials: PW
authors.lastname: Wilson
authors.affiliation: From TIMI Study Group, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (M.A.C., J.K., K.I., D.L.B.); French Alliance for Cardiovascular Clinical Trials, Département Hospitalo-Universitaire, Fibrosis, Inflammation, Remodeling, Université Paris-Diderot, Sorbonne Paris-Cité, Laboratory of Vascular Translational Science, INSERM U-1148, Hôpital Bichat, Hopitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); National Heart Lung Institute, Imperial College, Royal Brompton Hospital, London, UK (P.G.S.); University of North Carolina, Chapel Hill (S.C.S.); University of Michigan, Ann Arbor (K.E.); Duke Clinical Research Institute, Durham, NC (E.M.O.); Tokai University, Kanagawa, Japan (S.G.); and Emory University and the Atlanta VA Medical Center, Atlanta, GA (P.W.F.W.). DLBHATTMD@post.harvard.edu.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000175:diagnosis / Q000401:mortality*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011446:Prospective Studies; D012042:Registries; D013927:Thrombosis / Q000175:diagnosis / Q000401:mortality*; D013997:Time Factors; D016896:Treatment Outcome
keywords: coronary artery disease; diabetes mellitus; heart failure; registries