Development of Congestive Heart Failure in Type 2 Diabetic Patients With Microalbuminuria or Proteinuria

Abstract

FOR THE DIABHYCAR STUDY GROUPOBJECTIVE -The DIABHYCAR (type 2 DIABetes, Hypertension, CArdiovascular Events and Ramipril) study allowed investigators to analyze factors leading to the development of congestive heart failure (CHF) in type 2 diabetic patients with abnormal urinary albumin concentration.RESEARCH DESIGN AND METHODS -Type 2 diabetic subjects of both sexes aged Ն50 years who had a urinary albumin concentration Ն20 mg/l were randomly allocated to 1.25 mg/day ramipril or placebo in addition to their usual treatment and treated for 3-6 years in a double-blind fashion. Major outcomes including hospitalization for CHF were recorded during the follow-up.RESULTS -Of the 4,912 included patients, 187 developed CHF during the study. There was no significant difference in the incidence of CHF between the two treatment groups. Using a multivariate analysis, independent risk factors for the occurrence of CHF were age, history of cardiovascular disease, baseline urinary albumin concentration, baseline HbA 1c , and smoking habits. A total of 68 of the 187 patients (36.4%) died during the 12 Ϯ 11-month period after the first hospitalization for CHF, whereas the annual mortality rate of the population who did not develop CHF was 3.2%.CONCLUSIONS -Presence of atherosclerotic disease, baseline urinary albumin concentration, and HbA 1c level were indicators for further development of CHF. Occurrence of CHF is a major prognostic turn in a diabetic patient's life.

ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD – Summary

“…282 On the other hand, T2DM increased the risk of hospitalization in patients with heart failure in the BEta blocker STroke trial (BEST) 283 (RR1.16; P = 0.027). In the Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF), 284 patients with heart failure and T2DM had 1-year hospitalization of 31%, compared with 24% forthose free from DM.…”

“…In the DIABHYCAR study, the combination of heart failure and T2DM resulted in a mortality rate 12-times-as great as in patients with T2DM but without heart failure (36 vs.3%). 282 BEST and Studies Of Left Ventricular Dysfunction (SOLVD) 283,285 reported T2DM as an independent predictor of mortality, mostly in ischaemic heart failure.…”

Canadian Cardiovascular Society Consensus Conference guidelines on heart failure – 2008 update: Best practices for the transition of care of heart failure patients, and the recognition, investigation and treatment of cardiomyopathies

“…In several studies, the incidence of heart failure was two-and fourfold higher in patients with diabetes mellitus than in those without (54)(55)(56)(57)(58)(59). The development of heart failure in diabetes mellitus significantly increases mortality (61). Up to 30% of heart failure patients have diabetes mellitus (55,60,62).…”

“…How should I treat it? Although an increase in glycosylated hemoglobin in patients with diabetes mellitus is a risk factor for developing heart failure (54,61,70,71), studies have not demonstrated that glycemic control significantly reduces the incidence of heart failure (72). However, the 2003 Canadian Diabetes Association clinical practice guidelines for the prevention and management of diabetes in Canada (73) recommend that most patients with type 1 or 2 diabetes should be targeted to achieve a glycosylated hemoglobin level of 7.0% or less.…”

Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: Prevention, management during intercurrent illness or acute decompensation, and use of biomarkers

“…Data from the National Health Examination Survey I (22) and the Framingham study (17) have shown the incidence of heart failure in patients with diabetes mellitus to be two-and fourfold higher, respectively, than in patients without diabetes mellitus. While an increase in glycosylated hemoglobin (HbA1C) among patients with diabetes mellitus is a recognized risk factor for heart failure (23)(24)(25)(26)(27), no study to date has demonstrated that improved glycemic control significantly reduces the incidence of heart failure (28 …”