Elevated glycated haemoglobin is a strong predictor of mortality in patients with left ventricular systolic dysfunction who are not receiving treatment for diabetes mellitus

Goode, Kevin; John, Joseph; Rigby, Alan S.; Kilpatrick, Eric S.; Atkin, Stephen L.; Bragadeesh, Thanjuvar; Clark, Andrew L.; Cleland, John G.F.

doi:10.1136/hrt.2008.156646

Cited by 56 publications

(48 citation statements)

References 40 publications

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“…This might be partly attributed to differences both in the study design and in the clinical characteristics of patients enrolled in the GISSI‐HF trial (which was essentially a pragmatic, all‐comer–oriented clinical trial) and in the PARADIGM‐HF trial (which adopted very strict enrollment criteria, including the presence of LVEF <35% and the study drug tolerability in a long run‐in observational period). However, our findings are also consistent with those reported by Goode et al,14 who did not observe any significant increase in the risk of all‐cause death among nondiabetic CHF patients with a HbA1c level less than 6.5%.…”

Section: Discussionsupporting

confidence: 93%

“…Similarly, few studies have investigated the prevalence of pre‐DM in patients with CHF and even fewer its clinical consequences (and with conflicting findings) 9, 14, 20, 24…”

Section: Discussionmentioning

confidence: 99%

“…However, despite the existence of a significant association between hyperglycemia and adverse clinical outcomes in patients with HF,9, 13, 14, 15 no recommendations to identify specific glycemic goals or high‐risk patient groups have been provided so far, mainly because of the lack of compelling evidence on the benefit of universally achieving a strict glycemic control 16. Additionally, randomized, clinical trials that have explored the cardiovascular safety of the newer hypoglycemic drugs did not find any clear benefit on the risk of HF in patients with DM at high cardiovascular risk, except for opposite effects of empagliflozin (positive) and saxagliptin (negative) on the risk of HF hospitalization 17, 18, 19…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Impact of Diabetes and Prediabetes on Survival Outcomes in Patients With Chronic Heart Failure: A Post‐Hoc Analysis of the GISSI‐HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca‐Heart Failure) Trial

Dauriz

Targher

Temporelli

et al. 2017

JAHA

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BackgroundThe independent prognostic impact of diabetes mellitus (DM) and prediabetes mellitus (pre‐DM) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre‐DM on survival outcomes in the GISSI‐HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca‐Heart Failure) trial.Methods and ResultsWe assessed the risk of all‐cause death and the composite of all‐cause death or cardiovascular hospitalization over a median follow‐up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI‐HF trial, who were stratified by presence of DM (n=2852), pre‐DM (n=2013), and non‐DM (n=2070) at baseline. Compared with non‐DM patients, those with DM had remarkably higher incidence rates of all‐cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non‐DM patients and those with pre‐DM. Cox regression analysis showed that DM, but not pre‐DM, was associated with an increased risk of all‐cause death (adjusted hazard ratio, 1.43; 95% CI, 1.28–1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI, 1.13–1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all‐cause death: adjusted hazard ratio, 1.21; 95% CI, 1.02–1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI, 1.01–1.29, respectively).ConclusionsPresence of DM was independently associated with poor long‐term survival outcomes in patients with chronic heart failure.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00336336.

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Section: Discussionsupporting

confidence: 93%

“…Similarly, few studies have investigated the prevalence of pre‐DM in patients with CHF and even fewer its clinical consequences (and with conflicting findings) 9, 14, 20, 24…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prognostic Impact of Diabetes and Prediabetes on Survival Outcomes in Patients With Chronic Heart Failure: A Post‐Hoc Analysis of the GISSI‐HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca‐Heart Failure) Trial

Dauriz

Targher

Temporelli

et al. 2017

JAHA

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“…The prevalence of glucose intolerance in patients with HF was reported in several trials range from 23% to 43% [24][25][26][27] . A recent study conducted in Kameda Medical Center, Chiba, Japan showed that out of 136 subjects 46 (33.82%) had prediabetes, among them 9 (9.6%) had IFG, 37 (39.4%) had IGT 28 .…”

Section: Discussionmentioning

confidence: 99%

Frequency of Diabetes and Prediabetes in Heart Failure Patients and Their Association with In-Hospital Outcome

Begum¹,

Abdullah

Khan³

et al. 2014

Chatt Maa Shi Hosp Med Coll J

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Background: There are an increasing number of hospital admissions due to heart failure with diabetes or prediabetes in different hospitals in Bangladesh. But very little is known about the frequency of diabetes and prediabetes and the effect of its presence on the characteristics and outcome in patients hospitalized for heart failure. The objective of this study was to find out the frequency of diabetes and prediabetes in heart failure patients and to assess their association with in-hospital outcome. Methods: This cross sectional analytical study was done in the department of Biochemistry and Cardiology of Bangabandhu Sheikh Mujib Medical University in collaboration with department of Cardiology of National Institute of Cardiovascular Diseases, and Dhaka Medical College Hospital from July 2010 to June 2011. After proper ethical consideration a total two hundred and fifty heart failure patients were enrolled in the study by nonrandom sampling. Fasting blood sugar was done in all patients and oral glucose tolerance test was done in patients with impaired fasting glycaemia. Results: The frequency of prediabetes among the total population was 12.8% (95% CI,) and that of diabetes was 37.2% (95% CI, 31.2-43.2%). Improvement was achieved in 27 (84.4%) cases in prediabetic group, 75 (80.6%) cases in diabetic group and 105 (84.0%) cases in nondiabetic group. Mortality rates in prediabetes, diabetes and nondiabetes were 5 (15.6%); 18 (19.4%) and 20 (16.0%) respectively. The differences found among the three groups were not statistically significant (p>0.05). Length of hospital stay was also similar in all groups of study subjects. Conclusion: Frequency of diabetes among heart failure patients is high and pre-diabetes is not negligible in our country. Future studies in this field should focus on all types of glucose abnormalities rather than previously diagnosed diabetes only.

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“…From the publication of the UKPDS study onwards almost all studies targeting HbA1c levels <7.5% failed to show a cardiovascular benefit and often demonstrated an increased risk of cardiovascular mortality and morbidity, most often related to heart failure. [1,[14][15][16][17][18] In patients with heart failure and coexisting diabetes mellitus maintenance of adequate glycaemic control is a critical issue not only because of the relationship between glucose levels, heart function and outcomes but also because the choice of drugs available to safely manage glucose management in patients with heart failure is limited. [8,9] A meta-analysis of 13 high quality studies on 34,533 patients showed that intensive glucose lowering is not associated with any significant reduction in cardiovascular risk but conversely results in a 47% increase in HF risk (P<0.001).…”

Section: Introductionmentioning

confidence: 99%

The Management of Diabetic Patients with Heart Failure

Rosano¹,

Seferović²

2017

ICFJ

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Patients with diabetes mellitus have an increased risk of developing heart failure and diabetes mellitus is highly prevalent amongst patients with heart failure, especially those with HFpEF. Diabetic patients with heart failure have an increased mortality and an increased risk of hospitalisations and the use of certain anti- diabetic agents increase the risk of mortality and hospitalisation in heart failure. Conversely, newer therapeutic agents have shown a significant reduction of mortality, morbidity and risk of developing heart failure in diabetic patients with proven cardiovascular disease. This highly important area is reviewed in this paper.

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Elevated glycated haemoglobin is a strong predictor of mortality in patients with left ventricular systolic dysfunction who are not receiving treatment for diabetes mellitus

Abstract: The abrupt increase in mortality with HbA1c may make it a useful risk stratification tool in non-diabetic patients with LVEF

Cited by 56 publications

References 40 publications

Prognostic Impact of Diabetes and Prediabetes on Survival Outcomes in Patients With Chronic Heart Failure: A Post‐Hoc Analysis of the GISSI‐HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca‐Heart Failure) Trial

Prognostic Impact of Diabetes and Prediabetes on Survival Outcomes in Patients With Chronic Heart Failure: A Post‐Hoc Analysis of the GISSI‐HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca‐Heart Failure) Trial

Frequency of Diabetes and Prediabetes in Heart Failure Patients and Their Association with In-Hospital Outcome

The Management of Diabetic Patients with Heart Failure

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