Impact of Diabetes in Blacks with Heart Failure

Other studies have underestimated the prevalence of diabetes among the black population with heart failure.

It is known that diabetes is strong risk factor for coronary artery disease (CAD), and CAD itself is the most common cause of heart failure, but it has not been established whether diabetes alone contributes to the incidence of heart disease.

In this study examining the prevalence and impact of diabetes in black patients with heart failure, 286 patients, 92% black, it was found that 47% of the patients (135/286) had diabetes. Of these, 91 were classified as non-insulin dependent and 44 were insulin dependent. Senior investigator Dr. Judith Mitchell, of the department of medicine/cardiology at the State University of New York, in Brooklyn, New York, presented these findings at the Heart Failure Society of America 8th Annual Scientific Meeting.

The only parameter that did turn up any difference was that those with heart failure and diabetes were more likely to have elevated serum creatinine (> 1.5 mg/dL) compared with those who had heart failure but did not have diabetes.

The presence or absence of diabetes also had little bearing on the drugs used to treat these patients. Sixty-eight per cent of patients with diabetes received beta blockers in hospital, regardless of whether they had preserved or impaired systolic function, and 58% of all patients without diabetes received them. Aldosterone antagonists were used by 24% of patients with diabetes and 23% of patients without. It is worth noting, reported Dr. Mitchell, that 4 out of 5 patients with impaired systolic function, whether they had diabetes or not, were sent home with a prescription for beta blockers.

This study is important, the investigators said, because unlike other studies, which only enrolled a small number of patients from ethnic minorities, 98% of the enrollees here were black. With almost 50% of enrollees showing the presence of diabetes, this could indicate that other studies have underestimated the prevalence of diabetes among the black population with heart failure. Furthermore, the percentage of black patients with heart failure and insulin resistance or metabolic syndrome is largely unknown and therefore could be underestimated as well.

Since black patients with heart failure are already known to have higher morbidity and mortality rates than non-blacks, and since diabetes in itself is known to complicate the progression of heart failure, the two conditions in this group definitely warrants further study.

[Presentation title: Prevalence and Impact of Diabetes Mellitus in Black Patients Hospitalized with Heart Failure with Impaired or Preserved Systolic Function. Poster number: 423]

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