Issue 151 Item 14 Heart Failure Risk Estimated in Type 2 Diabetics With Microalb

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