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Insulin Linked to Higher Death Rate Among Patients with Heart Problems

People with advanced heart failure and who also have diabetes that requires insulin treatment have about a fourfold greater mortality rate than heart failure patients who don’t take insulin.

The new study may help raise awareness among physicians and patients of this previously unknown relationship between insulin use and increased mortality in advanced heart failure patients. More research is needed to explore the mechanisms of how insulin use may be contributing to the higher mortality rate.

Authors of the study include: Dr. Gregg Fonarow, senior study author; professor of cardiology, David Geffen School of Medicine at UCLA; and director, Ahmanson-UCLA Cardiomyopathy Center.

Previous studies have shown a connection between type 2 diabetes, heart failure and insulin. The UCLA study is the first to identify a high mortality rate for advanced heart failure patients who use insulin to manage diabetes. "Further studies into what is the best strategy to control blood sugar levels in patients with diabetes and heart failure are urgently needed," said Fonarow.
Researchers assessed the history of diabetes and insulin treatment in 554 patients with advanced heart failure after adjusting for various risk factors. One year survival rates were 89.7 percent for non-diabetic patients, 85.8 percent for non-insulin-treated diabetic patients, and only 62.1 percent for insulin-treated diabetic patients.

Heart failure affects 5 million in the United States and is the most common cause of hospitalization for those 65 years and older. Between 25 to 44 percent of heart failure patients also have diabetes.

American Heart Journal Jan, 2006 A PDF of the full study is available.
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