Glycemic Control and Heart Failure Among Adult Patients With Diabetes

Iribarren, Carlos; Karter, Andrew J.; Go, Alan S.; Ferrara, Assiamira; Liu, Jennifer Y.; Sidney, Stephen; Selby, Joseph V.

doi:10.1161/01.cir.103.22.2668

Cited by 597 publications

(315 citation statements)

References 34 publications

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“…Furthermore, it has been reported that poor glycemic control is associated with a higher rate of HF admissions [6]. For example, Iribarren et al [7], in a cohort of about 50,000 diabetic patients (none of whom had a reported history of HF), reported that each 1% increase in HbA1c correlated with an 8% increased risk of HF. Unfortunately, tightening the control of blood glucose did not appear to result in a decreased risk of HF [8].…”

Section: Discussionmentioning

confidence: 99%

Heart Failure as a Risk Factor for Diabetes Mellitus

Guglin¹,

Lynch

Krischer

2014

Cardiology

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Background: Diabetes mellitus (DM) is a well-recognized risk factor for heart failure (HF). We hypothesized that HF also increases the risk for DM. Objective: We explored the hypothesis that HF is a risk factor for DM. Methods: The Cardiovascular Health Study was a prospective cohort study of cardiovascular risk in ambulatory older adults. We used a limited-access dataset provided by the National Heart, Lung and Blood Institute. The impact of HF at baseline on DM after 3 or 4 years was examined in a cohort of 3,748 nondiabetic participants aged ≥65 years. The magnitude and significance of the association were evaluated using logistic regression models. Analyses were performed with and without adjustment for confounders and separately among subjects with normal and impaired fasting glucose at baseline. Results: Among subjects with normal fasting glucose at baseline, HF significantly increased the odds of developing impaired fasting glucose after 3 or 4 years [odds ratio (OR) 2.18, 95% confidence interval (CI) 1.03-4.61, p = 0.043] or overt DM (OR 4.78, 95% CI 1.84-12.4, p < 0.001). After adjusting for demographic and biomedical factors, HF remained significantly associated with a worsening DM status (OR 2.43, 95% CI 1.38-4.29, p = 0.002). Conclusions: In the elderly population, the presence of HF more than doubles the incidence of DM within a few years. This association remains significant when adjusting for age, gender and cardiovascular comorbidities.

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Section: Discussionmentioning

confidence: 99%

Heart Failure as a Risk Factor for Diabetes Mellitus

Guglin¹,

Lynch

Krischer

2014

Cardiology

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“…These include the accumulation of advanced glycation end products, altered calcium handling, increased reactive oxygen species (ROS) and activation of the renin-angiotensin system (Fiordaliso et al 2004, Ligeti et al 2006, Goh & Cooper 2008, Yao & Brownlee 2010, Thomas et al 2013. Indeed, a study of almost 50,000 individuals with diabetes demonstrated that, for each 1% increase in glycated haemoglobin, there was an 8% increase in the risk of heart failure (Iribarren et al 2001). Interestingly, this effect was observed independent of hypertension status, consistent with the finding that diabetic cardiomyopathy can occur in the absence of hypertension as mentioned previously (Rubler et al 1972, Regan et al 1977.…”

Section: Introductionmentioning

confidence: 99%

Lipid metabolism and its implications for type 1 diabetes-associated cardiomyopathy

Ritchie

Zerenturk

Prakoso

et al. 2017

Journal of Molecular Endocrinology

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Diabetic cardiomyopathy was first defined over four decades ago. It was observed in small post-mortem studies of diabetic patients who suffered from concomitant heart failure despite the absence of hypertension, coronary disease or other likely causal factors, as well as in large population studies such as the Framingham Heart Study. Subsequent studies continue to demonstrate an increased incidence of heart failure in the setting of diabetes independent of established risk factors, suggesting direct effects of diabetes on the myocardium. Impairments in glucose metabolism and handling receive the majority of the blame. The role of concomitant impairments in lipid handling, particularly at the level of the myocardium, has however received much less attention. Cardiac lipid accumulation commonly occurs in the setting of type 2 diabetes and has been suggested to play a direct causal role in the development of cardiomyopathy and heart failure in a process termed as cardiac lipotoxicity. Excess lipids promote numerous pathological processes linked to the development of cardiomyopathy, including mitochondrial dysfunction and inflammation. Although somewhat underappreciated, cardiac lipotoxicity also occurs in the setting of type 1 diabetes. This phenomenon is, however, largely understudied in comparison to hyperglycaemia, which has been widely studied in this context. The current review addresses the changes in lipid metabolism occurring in the type 1 diabetic heart and how they are implicated in disease progression. Furthermore, the pathological pathways linked to cardiac lipotoxicity are discussed. Finally, we consider novel approaches for modulating lipid metabolism as a cardioprotective mechanism against cardiomyopathy and heart failure.

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“…Prior data predictive of HF in asymptomatic diabetics are limited, particularly over a long period of observation [20,21]. In a recent echo-Doppler-based study in type 2 diabetics, measures of LV diastolic dysfunction correlated with CV outcomes but HF was not examined [19].…”

Section: Discussionmentioning

confidence: 99%

Cardiac Computed Tomography Angiographic Findings as Predictors of Late Heart Failure in an Asymptomatic Diabetic Cohort: An 8-Year Prospective Follow-Up Study

Halon¹,

Jubran²,

Rubinshtein³

et al. 2017

Cardiology

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Objectives: Predictive models for heart failure (HF) in heterogeneous populations have had limited success. We examined cardiac computed tomography angiography (CTA) predictors of HF or cardiovascular death (HF-CVD) in a prospective study of asymptomatic diabetics undergoing baseline assessment by CTA. Methods: The subjects (n = 735, aged 55-74 years, 51.2% women) had no clinical history of cardiovascular disease at study entry. Coronary artery calcium (CAC) score, CTA-defined coronary atherosclerosis, cardiac chamber volumes, and clinical data were collected and late outcome events recorded over 8.4 ± 0.6 years (range 7.3-9.3). Results: HF-CVD occurred in 41 (5.6%) subjects, with HF occurring mostly (19/23, 82.6%) in subjects without preceding myocardial infarction. Baseline univariate clinical outcome predictors of HF-CVD included older age (p = 0.027), the duration of diabetes (p = 0.004), HbA1c (p < 0.0001), microvascular disease (retinopathy, microalbuminuria) (p < 0.0001), and systolic blood pressure (p = 0.035). Baseline univariate CTA predictors included CAC score (p = 0.004), coronary stenosis (p = 0.047), and a CTA-defined left/right atrial (LA/RA) volume ratio >1 (p < 0.0001). Independent predictors were an LA/RA volume ratio >1, microvascular disease, and systolic blood pressure (model C-statistic 0.792, 95% CI 0.758-0.824). Measures of the extent of coronary artery disease (CAD) were not independent predictors of HF-CVD. Conclusions: In a low- to moderate-risk asymptomatic diabetic population, CTA LA enlargement (LA/RA volume ratio) but not the extent of CAD had independent prognostic value for HF-CVD in addition to the clinical variables.

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Glycemic Control and Heart Failure Among Adult Patients With Diabetes

Abstract: These results confirm previous evidence that poor glycemic control may be associated with an increased risk of heart failure among adult patients with diabetes.

Cited by 597 publications

References 34 publications

Heart Failure as a Risk Factor for Diabetes Mellitus

Heart Failure as a Risk Factor for Diabetes Mellitus

Lipid metabolism and its implications for type 1 diabetes-associated cardiomyopathy

Cardiac Computed Tomography Angiographic Findings as Predictors of Late Heart Failure in an Asymptomatic Diabetic Cohort: An 8-Year Prospective Follow-Up Study

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