Poor Diabetes Control Boosts Heart Failure Risk

The highest incidence of heart failure occurred in patients with a baseline HbA1c level of more than 8%.: For every 1% increase in serum HbA1c, the risk of heart failure rose by 15%.

Higher levels of hemoglobin A1c significantly boosted the risk of heart failure in patients with diabetes in an analysis of more than 1,800 patients.

This association was seen even among patients with diabetes who did not have clinically apparent coronary heart disease (CHD), suggesting that poorly controlled hyperglycemia plays a direct role in causing heart failure, Dr. Antonio Pazin-Filho said at a conference on cardiovascular disease epidemiology and prevention sponsored by the American Heart Association.
The likely mechanism for this link is an increased risk of diabetic cardiomyopathy in patients with poorly controlled hyperglycemia, said Dr. Pazin-Filho, an epidemiologist at Johns Hopkins University in Baltimore.

“The message is that patients with diabetes may benefit more if they can reach their glycemia goal,” commented Dr. Peter W.F. Wilson, professor of medicine at Emory University in Atlanta. “It's another reason why tight glycemic control is important.” The data also suggested that the risk of heart failure from hyperglycemia was the highest among patients treated with insulin, suggesting that diabetic patients on insulin face the biggest risk from heart failure if they cannot maintain good glycemic control, Dr. Wilson said in an interview.

The study used data collected from people in the Atherosclerosis Risk in Communities study, a prospective study of nearly 16,000 people from four communities in the United States that began in 1987. The analysis by Dr. Pazin-Filho focused on 1,827 subjects who had been diagnosed with diabetes in their examinations during 1990–1992. These patients were then followed for about 10 years, through the end of 2002. At baseline, 1,668 patients did not have CHD, and 159 did have CHD.

During follow-up, 205 of the patients without CHD developed heart failure, defined as a first hospitalization for heart failure or death because of heart failure. Incident heart failure also occurred in 50 patients who had CHD at baseline. The 205 people who developed heart failure without preexisting CHD were further divided into 118 who developed heart failure without first being diagnosed with clinically apparent CHD during follow-up, and 87 who were first diagnosed with CHD during follow-up before their heart failure appeared.

Dr. Pazin-Filho and his associates then analyzed the risk that these patients faced for developing heart failure relative to their serum level of hemoglobin A1c at baseline. The results showed that among patients with diabetes who did not have preexisting CHD, the risk of later developing heart failure was significantly linked to their HbA1c level. For each 1% increase in HbA1c at baseline, the risk of heart failure rose by 13% in an analysis that controlled for potential confounding factors at baseline including age, gender, race, education, health-insurance status, alcohol intake, smoking status, blood pressure, and serum lipid levels.

When the analysis excluded the 87 people who developed CHD before heart failure during follow-up, the link between baseline levels of HbA1c and risk for heart failure was even stronger: For every 1% increase in serum HbA1c, the risk of heart failure rose by 15%, also a statistically significant effect.

However, among the patients who had preexisting CHD at baseline, the analysis showed no significant relationship between HbA1c levels and the risk of developing heart failure.

“Our results support the idea that the better the glycemic control the lower the risk,” Dr. Pazin-Filho said in an interview. The usual goal for patients with diabetes is a serum level of HbA1c that's 7% or less; normal levels are 6% or less. In the findings reported by Dr. Pazin-Filho, the highest incidence of heart failure occurred in patients with a baseline level of more than 8%.
Internal Medicine News: Volume 40, Issue 7, Page 43 (01 April 2007)

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FACT:

Survey: 13% of Adult New Yorkers Are Diabetic: A new citywide survey finds that nearly 13% of the city's adults have diabetes and that about one-third of them—almost 4% of city residents—do not know it. The first New York City Health and Nutrition Examination Survey (HANES)—and the first community-level HANES survey in the country, health department officials say—used a one-time screening test to estimate diabetes prevalence among approximately 2,000 randomly selected New Yorkers from 144 neighborhoods across all boroughs. The survey also shows that another 23.5% of adults have prediabetes and that nearly half of all Asian New Yorkers have either diabetes or prediabetes, according to press officials at the New York City Department of Health and Mental Hygiene. The prevalence of diabetes among Asians, the survey shows, is 16% (nearly 1 in 6). Significantly more Asians—32%–-have prediabetes compared with other ethnic groups. Among men and women of all ethnicities who have diabetes, the findings show, 52% have well-controlled diabetes (A1c less than 7), 32% have moderately poorly controlled blood sugar, and about 16% have very poorly controlled blood sugar (A1c greater than 9%). Poor diabetes control appears to be common even among people with access to health care. Of New Yorkers with diagnosed diabetes that is uncontrolled, 94% have some sort of health insurance, including Medicaid.