Association between glycated haemoglobin and the risk of congestive heart failure in diabetes mellitus: systematic review and meta‐analysis

Abstract

BackgroundClinical trials to date have not provided definitive evidence regarding the effects of glucose lowering on the incidence of congestive heart failure (CHF). We synthesized available prospective epidemiological data on the association between glycaemia measured by haemoglobin A 1c (HbA 1c ) and incident CHF in individuals with diabetes. Methods and resultsWe searched electronic databases and reference lists of selected articles for relevant prospective epidemiological studies. We abstracted data from relevant studies using standardized forms and obtained additional data from investigators when required. We pooled study-specific relative risk estimates using random-effects model meta-analysis.Of the 1044 citations identified, we included 10 studies comprising 178 929 participants with diabetes and 14 176 incident CHF cases. Five studies included only patients with type 2 diabetes, four studies had predominantly patients with type 2 diabetes, and one study included only patients with type 1 diabetes. All studies except one showed an increased risk of CHF with higher HbA 1c . The overall adjusted risk ratio (RR) for CHF was 1.15 [95% confidence interval (CI) 1.10-1.21] for each percentage point higher HbA 1c . There was substantial heterogeneity across the 10 studies (I 2 : 83%; 95% CI 69 -91%; P , 0.001) not explained by available study-level characteristics such as study design or average HbA 1c level. In seven studies reporting RRs with more than one degree of adjustment, the association was minimally altered after adjustment for several cardiovascular risk factors. ConclusionsIn observational studies of individuals with diabetes, a higher HbA 1c level was associated with a significantly increased incidence of CHF.--

The long and unfinished journey of hyperglycaemia and heart failure research

“…In this context, it is not very surprising to see that the updated mean HbA1c measure (which implicitly but not fully controls for regression dilution bias resulting from single measurements) shows a much stronger association than a single baseline HbA1c value. In fact, the strength of association from the repeated measure HbA1c associations is highly consistent with a meta-analysis of observational studies that showed an adjusted risk ratio of 1.15 (95% CI 1.10 to 1.21) for each 1 percentage point higher HbA1c 5. However, the totality of evidence to date without the present study has been based on about 14 000 heart failure events from 10 heterogeneous studies with no clear indication that these studies had controlled for regression dilution bias 5.…”

“…In fact, the strength of association from the repeated measure HbA1c associations is highly consistent with a meta-analysis of observational studies that showed an adjusted risk ratio of 1.15 (95% CI 1.10 to 1.21) for each 1 percentage point higher HbA1c 5. However, the totality of evidence to date without the present study has been based on about 14 000 heart failure events from 10 heterogeneous studies with no clear indication that these studies had controlled for regression dilution bias 5. Taken together, it seems appropriate to conclude that among patients with type 2 diabetes each 1 percentage point higher ‘usual’ (ie, long-term average) HbA1c is associated with a 15% higher risk of heart failure.…”

Effect of dipeptidyl peptidase-4 inhibitors on heart failure: A meta-analysis of randomized clinical trials

“…Page 11 of 27 by themselves [58][59][60][61][62], it is logical to believe that this subset of patients may also be the ones who are most vulnerable to such adverse drug event. This is very much in line with our general understanding of how important baseline characteristic is in the development of an adverse drug event.…”

Clinical profile of diabetic patients with heart failure admitted in tertiary care teaching hospital, Kishanganj, Bihar- An Observational Study

“…9 Similarly, in a number of prospective observational studies in type 2 diabetes there is a consistent linear relationship between glycaemic control and heart failure, such that overall adjusted risk ratio (RR) for CHF was 1.15 [95% confidence interval (CI) 1.10-1.21] for each percentage point higher HbA1c. 10 Heart failure is a clinical diagnosis. 11 An ejection fraction (EF) of <50% in a patient with heart failure symptoms is termed heart failure with reduced ejection fraction (HFrEF), and an EF of ≥50% in a patient with heart failure symptoms is termed heart failure with preserved EF (HFpEF).…”