Diabetes, Glycemic Control, and New-Onset Heart Failure in Patients With Stable Coronary Artery Disease
Data from the Heart and Soul Study
- Joost P. van Melle, MD, PHD1,
- Mariska Bot, MSC2,
- Peter de Jonge, PHD2,3,
- Rudolf A. de Boer, MD, PHD1,
- Dirk J. van Veldhuisen, MD, PHD1 and
- Mary A. Whooley, MD, PHD4
- 1Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands;
- 2Department of Medical Psychology, Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands;
- 3Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands;
- 4San Francisco Veterans Affairs Medical Center and the University of California, San Francisco, San Francisco, California.
- Corresponding author: Joost P. van Melle, j.p.van.melle{at}thorax.umcg.nl.
Abstract
OBJECTIVE Diabetes is a predictor of both coronary artery disease (CAD) and heart failure. It is unknown to what extent the association between diabetes and heart failure is influenced by other risk factors for heart failure.
RESEARCH DESIGN AND METHODS We evaluated the association of diabetes and A1C with incident heart failure in outpatients with stable CAD and no history of heart failure (average follow-up 4.1 years).
RESULTS Of 839 participants, 200 had diabetes (23.8%). Compared with patients who did not have diabetes, those with diabetes had an increased risk of heart failure (hazard ratio [HR] 2.17 [95% CI 1.37–3.44]). Adjustment for risk factors for CAD (age, sex, race, smoking, physical inactivity, obesity, blood pressure, and LDL cholesterol), interim myocardial infarction, and myocardial ischemia did not alter the strength of the association between diabetes and heart failure. After inclusion also of other risk factors for heart failure (left ventricular ejection fraction, diastolic dysfunction, and C-reactive protein) and medication use, diabetes remained an independent predictor of heart failure (HR 3.34 [95% CI 1.65–6.76]; P = 0.001). Each 1% increase in A1C concentration was associated with a 36% increased HR of heart failure hospitalization (HR 1.36 [95% CI 1.17–1.58]).
CONCLUSIONS In patients with stable CAD who are free from heart failure at baseline, diabetes and glycemic control are independent risk factors for new-onset heart failure. The mechanisms by which diabetes and hyperglycemia lead to heart failure deserve further study, as the association is independent of baseline functional assessment of ischemia, systolic and diastolic function, and interim myocardial infarction.
Footnotes
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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See accompanying editorial, p. 2120.
- Received February 13, 2010.
- Accepted May 11, 2010.
- © 2010 by the American Diabetes Association.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
