Diabetes Increasingly Prevalent in Heart Failure

The prevalence of diabetes mellitus is increasing among older persons with heart failure, and diabetes is a significant independent risk factor for death in these patients The findings, underscore the importance of tight control of diabetes, researchers at the Mayo Clinic in Rochester, Minnesota, assert.

Dr. Aaron M. From and associates analyzed a random sample of 665 subjects living independently in Olmstead County who were first diagnosed with heart failure between 1979 and 1999. Mean age was 77 years and 20% had a pre-existing diagnosis of diabetes.

Those with diabetes tended to be younger, had lower left ventricular ejection fractions and a greater body mass index than heart failure patients without diabetes.

The prevalence of diabetes increased 3.8% per year. The odds of having diabetes for those first diagnosed with heart failure in 1999 was nearly four times higher than those diagnosed 20 years earlier in 1979.

Five-year survival was 46% for those with heart failure alone, but only 37% for those with heart failure and diabetes.

Counterintuitively, subjects with diabetes and no coronary artery disease had a higher risk of death (relative risk =1.79) than those with diabetes and coronary disease (RR = 1.11), compared to patients with neither diabetes nor CAD. The authors suggest this finding may reflect under-recognition of CAD in diabetic subjects.

The increasing prevalence of diabetes and its associated increase in risk of death "delineates a substantial opportunity to improve the outcome of HF by preventing diabetes and, once present, by aggressively evaluating and treating it," Dr. From and colleagues conclude.

Am J Medicine 2006;119:591-599.

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