Issue 154 Item 9 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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