Glucose Level Predicts Hospitalization for Congestive Heart Failure 

In diabetic patients at risk for congestive heart failure (CHF), fasting plasma glucose level is an independent predictor for hospitalization, according to the results of a study. "Patients with diabetes mellitus (DM) are at high risk of developing congestive heart failure (CHF)," write C. Held, MD, PhD, from the Karolinska University Hospital in Stockholm, Sweden, and colleagues. "However, the relationships between glucose levels and CHF in people with or without a history of DM have not been well characterized."

The investigators evaluated the associations between fasting plasma glucose level and risk for hospitalization for CHF during follow-up in 31,546 patients at high cardiovascular risk but without CHF who were enrolled in a large-scale clinical trials program. High-risk was defined as the presence of one coronary, peripheral, or cerebrovascular disease or DM with end-organ damage.

Subjects were enrolled in 1 of 2 ongoing parallel trials evaluating the effects of telmisartan, ramipril, or their combination.
At a mean follow-up of 886 days, interim analyses blinded for randomized treatment were performed to compare baseline fasting plasma glucose level with the adjusted CHF event rate. During follow-up, 68 patients were hospitalized for CHF. A 1-mmol/L higher fasting plasma glucose level was associated with a 1.10-fold increased risk for CHF hospitalization after adjustment for age and sex.

"Fasting plasma glucose is an independent predictor of hospitalization for CHF in high-risk subjects," the authors write. "These data provide theoretical support for potential direct beneficial effects of glucose lowering in reducing the risk of CHF and suggest the need for specific studies targeted at this issue."

"The present study represents a large and unique cohort with a relatively long period of follow-up and a large number of CHF events, thus providing a suitable setting and high statistical power to explore the significance of glucose on the development of CHF," the authors conclude. "Although we have shown that FPG [fasting plasma glucose] independently predicts hospitalization for CHF, whether glucose lowering reduces the risk of CHF requires study in prospective, randomized studies designed specifically for this purpose."

Pearls for your practice:

• Elevated blood glucose levels may contribute to an increased risk for CHF through increasing left ventricular mass, increasing the risk for coronary artery disease, accelerating endothelial apoptosis, and reducing cardiac output.
• The current study demonstrates that increasing levels of fasting plasma glucose, even among patients without diabetes, increase the risk for incident hospitalization for CHF.

Circulation. Published online March 5, 2007

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