Advanced Heart Failure Associated With Development
of Diabetes
Patients with advanced heart failure appear have
a significantly increased risk of developing diabetes,
starting at 6 years after diagnosis of heart failure,
according to the results of a study.
"
Recent reports suggest that decreased functional
capacity in patients with heart failure may be associated
with abnormalities in glucose metabolism," Dr.
Alexander Tenenbaum and colleagues from the Chaim
Sheba Medical Center, Tel-Hashomer, Israel, note.
They examined the association between cardiac
functional status and the development of
diabetes in 2616 nondiabetic
patients with previous myocardial infarction or
stable angina pectoris over 7.7 years. The
subjects were
participants in the Bezafibrate Infarction Prevention
Study, conducted at 18 university hospitals.
The patients were between the ages of 45 and
74 years and had a fasting blood glucose
level less
than 7
mmol/L, they report in the March issue of the
American Journal of Medicine. The subjects
were divided
into three groups based on New York Heart Association
(NYHA) criteria class I (n = 1986), class II
(n =
518), and class III (n = 112). Demographic and
clinical characteristics were similar in all
three groups.
Thirteen percent and 15% of patients with class
I and class II heart failure, respectively,
developed diabetes during follow-up, compared
with 20%
in class
III (p = 0.05), they report.
"
Substantial increases (more than 1 mmol/L) in the
fasting blood glucose level (last versus first visit)
occurred more frequently among patients with advanced
heart failure," they write. Patients in class
III were twice as likely to have fasting blood glucose
levels of 7 mmol/L or higher at the last visit than
patients with class I or II disease (p = 0.005).
Multivariate analysis revealed that NYHA class
III independently predicted the development
of diabetes
(HR = 1.7), but NYHA class II did not (HR
= 1.0).
While diabetes is a known independent risk
factor for heart failure, "only one previous study,
in a group of elderly subjects, reported that heart
failure was associated with the subsequent development
of diabetes," Dr. Tenenbaum's group notes. "Our
results support that observation."
Am J Med 2003;114:271-275.
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