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Item #14
Heart
Failure Risk Estimated in Type 2 Diabetics With Microalbuminuria
New
findings confirm that congestive heart failure (CHF) occurs frequently
and is associated with a poor prognosis in type 2 diabetics with
elevated urinary albumin concentration (UAC).
They
also provide a better idea of which patients are at greatest risk for
developing heart failure.
French
investigators led by Dr. Laurent Vaur from Aventis Laboratories in
Paris analyzed risk
factors
for the development of CHF in 4912 type 2 diabetics aged 50 or older
who, at entry, were free of symptomatic CHF and had an elevated UAC
(>/= 20 mg/L). The patients were participants in a
placebo-controlled trial assessing the effects of a low dose of the
ACE inhibitor ramipril (1.25 mg/day) on cardiovascular and renal
events in type 2 diabetics with microalbuminuria or proteinuria.
The
team reports in the March issue of Diabetes Care that 187 patients
developed CHF during the study. There was no significant difference in
the incidence of CHF between ramipril- and placebo-treated subjects.
However,
type 2 diabetics who developed CHF were more likely to be older, to
smoke, to have a history of cardiovascular disease, and to have higher
baseline UAC and mean baseline HbA1c levels compared with type 2
diabetics who did not develop heart failure. In multivariate analyses,
these factors emerged as independent risk factors for the development
of CHF.
The
study results, underline, that in diabetic patients with elevated UAC,
the higher the UAC level, the higher the risk of later developing CHF
and " each 10-fold increase in baseline UAC was associated with a
more than doubled risk of CHF, said Dr. Vaur.
Dr.
Vaur's team also reports that the 1-year mortality rate in patients
developing CHF was 36%, which is "in line with...previous results
and confirms the poor prognosis of diabetic patients developing heart
failure." In contrast, "the annual mortality rate of the
population who did not develop CHF was 3.2%," Dr. Vaur noted.
"These
data," he said, "warrant a reevaluation of strategies for
preventing and treating heart failure in the rapidly growing
population of elderly type 2 diabetic patients."
Diabetes
Care 2003;26:855-860
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