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EASD: Type 2 Diabetes plus Ischemic Heart Disease Can Predict Mortality

Oct 3, 2014

Long-term mortality of patients with ischemic heart disease is independently predicted by diabetes….

Anna Norhammar, MD, PhD, of the cardiology unit in the department of medicine at Karolinska Institutet in Sweden, said during her presentation, “Diabetes is common among patients with heart failure that report ischemic heart disease and it’s an independent predictor for long-term diagnosis not explained by lower ejection fraction (EF) or estimated glomerular filtration rate.”

Norhammar and colleagues evaluated 5,265 patients with type 2 diabetes and 12,408 patients without type 2 diabetes, all with previously reported ischemic heart failure to determine the effect of diabetes on long-term prognosis. Fifty percent of participants underwent revascularization.

Compared with patients without diabetes, patients with diabetes were younger (aged 75 vs. 77 years), had preserved renal function more often (>60 mL/min; 44% vs. 38%), and were more likely to have hypertension (59% vs. 45%) and heart failure symptoms (New York Heart Association functional classification III-IV; 53% vs. 46%). Both groups had an ejection fraction ≥50% (17% for both).

Norhammar stated that, “Pharmacological treatment was given more often to patients with diabetes.” These included beta-blockers (88%), angiotensin-converting-enzyme inhibitors (61%), statins (67%) and aspirin (71%).

Patient data was adjusted for the following: age, gender, duration of heart failure, weight, blood pressure, hypertension, atrial fibrillation, pulmonary disease, ejection fraction class, revascularization, eGFR class, hemoglobin class and pharmacological treatment. Among patients with diabetes, the unadjusted OR for mortality was 1.38 (95% CI, 1.24-1.41) and the adjusted OR was 1.71 (95% CI, 1.56-1.86). Among 50% of patients who underwent revascularization, the unadjusted and adjusted ORs for mortality were 1.52 (95% CI, 1.39-1.67) and 1.63 (95% CI, 1.45-1.84), respectively.

The most severe diagnosis was seen in patients with diabetes without revascularization. “Revascularization did not abolish the prognostic impact of diabetes.” The use of statins and revascularization was low in patients with diabetes considering that all patients reported had a report of ischemic heart disease. So, maybe an earlier identification of coronary artery disease, improved treatment and the more optimized timing of revascularization could prevent heart failure development and improve the prognosis of patients with diabetes.”

Norhammar A. Abstract #44. Presented at: 50th EASD Annual Meeting; Sept. 16-19, 2014; Vienna.