Elevated fasting glucose levels are predictive of incident congestive heart failure (CHF) among older adults with diabetes mellitus (DM). "Diabetes mellitus and CHF frequently coexist in the elderly," Dr. Joshua I. Barzilay, of Kaiser Permanente of Georgia, in Tucker, and colleagues write in the June 16th issue of the Journal of American College of Cardiology. "It is not clear whether fasting glucose levels in the setting of DM are a risk factor for incident CHF in the elderly."
The researchers followed 829 patients without prevalent CHF for 5 to 8 years, and used Cox proportional hazards models to assess the risk of CHF by fasting glucose levels. The team grouped the patients by the presence or absence of prevalent coronary heart disease.
A total of 123 incident CHF events occurred in the 626 patients without coronary heart disease at baseline. Among these 626 patients, a 1 standard deviation increase in fasting glucose level (60.6 mg/dL) resulted in a 41% increased risk of CHF (p < 0.0001) in adjusted analyses. Among those with prevalent coronary heart disease at baseline, a 1 standard deviation increase was associated with a 27% increased risk of CHF (p < 0.05).
Dr. Barzilay stated that, "Careful attention should be paid to glucose control in people with diabetes so as to prevent heart failure, especially those with underlying heart disease."
"Our data are observational and require replication," Dr. Barzilay cautioned. "An ongoing prospective, randomized study called the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial will be able to see if our findings can be replicated and at what glucose level heart failure risk increases."
J Am Coll Cardiol 2004;43:2236-2241.
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