The Incidence of Congestive Heart Failure in Type 2 Diabetes
An update
- Gregory A. Nichols, PHD1,
- Christina M. Gullion, PHD1,
- Carol E. Koro, PHD2,
- Sara A. Ephross, PHD2 and
- Jonathan B. Brown, PHD, MPP1
- 1Kaiser Permanente Center for Health Research, Portland, Oregon
- 2GlaxoSmithKline, Collegeville, Pennsylvania
- Address correspondence and reprint requests to Gregory A. Nichols, PhD, Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227-1098. E-mail: greg.nichols{at}kpchr.org
Abstract
OBJECTIVE—The aims of this study were to update previous estimates of the congestive heart failure (CHF) incidence rate in patients with type 2 diabetes, compare it with an age- and sex-matched nondiabetic group, and describe risk factors for developing CHF in diabetic patients over 6 years of follow-up.
RESEARCH DESIGN AND METHODS—We performed a retrospective cohort study of 8,231 patients with type 2 diabetes and 8,845 nondiabetic patients of similar age and sex who did not have CHF as of 1 January 1997, following them for up to 72 months to estimate the CHF incidence rate. In the diabetic cohort, we constructed a Cox regression model to identify risk factors for CHF development.
RESULTS—Patients with diabetes were much more likely to develop CHF than patients without diabetes (incidence rate 30.9 vs. 12.4 cases per 1,000 person-years, rate ratio 2.5, 95% CI 2.3–2.7). The difference in CHF development rates between persons with and without diabetes was much greater in younger age-groups. In addition to age and ischemic heart disease, poorer glycemic control (hazard ratio 1.32 per percentage point of HbA1c) and greater BMI (1.12 per 2.5 units of BMI) were important predictors of CHF development.
CONCLUSIONS—The CHF incidence rate in type 2 diabetes may be much greater than previously believed. Our multivariate results emphasize the importance of controlling modifiable risk factors for CHF, namely hyperglycemia, elevated blood pressure, and obesity. Younger patients may benefit most from risk factor modification.
- CHF, congestive heart failure
- ESRD, end-stage renal disease
- ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification
- KPNW, Kaiser Permanente Northwest
- UKPDS, U.K. Prospective Diabetes Study
Footnotes
-
G.A.N., C.M.G., and J.B.B. receive funding from several firms that manufacture drugs marketed to treat diabetes (GlaxoSmithKline, Eli Lilly, and Wyeth) and may, in the future, receive support from other companies in these markets. All of this research group’s contracts explicitly specify their right to publish any and all research results arising from commercial funding, without approval from the funder.
This research group’s study site, Kaiser Permanente Northwest Region (KPNW), is a nonprofit group-model prepaid medical care organization. The Center for Health Research (CHR) is an affiliated not-for-profit organization dedicated to producing public-domain research in the public interest. The CHR is scientifically and professionally independent of the larger Kaiser Permanente organization. Apart from an annual charitable contribution from KPNW, CHR scientists set their own research agendas and secure their research funding from external sources, usually the National Institutes of Health. KPNW neither reviews nor approves the publications of CHR scientists.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
-
- Accepted April 19, 2004.
- Received January 26, 2004.
- DIABETES CARE
