AJM Theme Issue: Cardiology
Clinical research study
Diabetes in Heart Failure: Prevalence and Impact on Outcome in the Population

https://doi.org/10.1016/j.amjmed.2006.05.024Get rights and content

Abstract

Purpose

Little is known on the prevalence and prognostic importance of diabetes mellitus (DM) among individuals with heart failure (HF) in community-based cohorts.

Methods

Within Olmsted County, Minnesota, a random sample of all subjects with a first diagnosis of HF between 1979 and 1999 was validated using Framingham criteria. DM was validated using glycemic criteria.

Results

Among 665 subjects with HF (mean age 77 ± 12 years, 46% male), 20% had prior DM. Subjects with DM were younger, had greater body mass index (BMI), and lower left ventricular ejection fraction than subjects without diabetes. The prevalence of DM increased markedly over time (3.8% per year; 95% confidence interval [CI], 0.8 to 6.9; P = .024), independently of BMI, particularly in older subjects (odds ratio of having DM in 1999 compared with 1979 was 3.93 [95% CI, 1.57 to 9.83] in subjects ≥75 years vs. 1.11 [95% CI, .40 to 3.05] in subjects <75 years). Five-year survival was 37% among subjects with DM versus 46% among subjects without (P = .017). The risk of death associated with DM differed markedly according to clinical coronary artery disease (CAD) (P = .025). Subjects with DM and no CAD had a higher risk of death (relative risk [RR] = 1.79 [95% CI, 1.33 to 2.41]) than those with CAD (RR = 1.11 [95% CI, .81 to 1.51]), independently of age, sex, BMI, renal function, calendar year of HF, comorbidity and EF.

Conclusions

Among community-dwelling patients with HF, the prevalence of DM increased markedly over time. DM is associated with a large increase in mortality, particularly among subjects without clinical CAD, underscoring the importance of aggressive management of DM in HF.

Section snippets

Study Setting

This study was conducted in Olmsted County, Minnesota. Epidemiologic studies in Olmsted County are possible because the county is relatively isolated, and only a few providers deliver nearly all health care to local residents. Health care providers in Olmsted County include the Mayo Clinic, Olmsted Medical Center, and a handful of private practitioners. Each medical provider uses a comprehensive medical record system in which the details of every encounter are entered and can be easily

Baseline Characteristics

Six hundred fifty-five subjects with confirmed incident HF between 1979 and 1999 were included in the study. The mean age of the cohort was 77 ± 12 years (mean ± SD), 46% were men, 20% had diabetes, and 38% had clinical CAD.

Forty-two percent of patients were diagnosed in the outpatient setting. Those diagnosed in the hospital had a lower BMI (P = .01) and creatinine clearance (P <.001). They were more likely to have comorbidities (P = .005) and clinical CAD (P <.001).

There were several differences in

Discussion

Over the past 2 decades, the prevalence of DM within a community-based cohort of subjects with HF increased markedly, independently of BMI. This increase was particularly large among older subjects, who form the majority of subjects with HF, further underscoring the growing burden of DM within HF, a disease itself of epidemic proportions.

DM was associated with a large increase in the risk of death after HF, independent of age, sex, creatinine clearance, comorbidity, ejection fraction, and year

Conclusion

Among community-dwelling subjects who present with HF, the prevalence of DM is high and has increased markedly over time independently of BMI, particularly among older subjects. DM is associated with a large increase in the risk of death, independently of age, sex, BMI, renal function, comorbidity, ejection fraction, and year of HF. This risk is modulated by the presence or absence of clinical CAD; the risk of death related to DM after HF diagnosis is the highest when CAD is not clinically

Acknowledgment

We thank Kay A. Traverse, RN and Diane M. Tri, RN for assistance with data collection, and Ryan A. Meverden, BS for assistance with data analysis.

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