Impaired fasting glucose: a predictor of reduced survival in patients with heart failure

Abstract

Aims Glucose abnormalities are associated with heart failure (HF), are increasingly prevalent, and may have an impact on outcome. Our aim was to evaluate the effect of fasting glucose levels on clinical outcome in patients with HF. Methods and results Patients with a diagnosis of HF as coded at a health maintenance organization in Jerusalem, Israel were evaluated retrospectively. Impaired fasting glucose (IFG) was defined as fasting plasma glucose levels between 100 and 125 mg/dL. All patients were followed for cardiac‐related hospitalizations and death. A total of 6067 HF patients were included. Mean follow‐up was 487 days; mean age 75 ± 13 years; 48% of the patients (n = 2,942) had diabetes; and 11.9% (n = 722) had IFG. Overall survival during the follow‐up was 82.5%. Cox regression analysis after adjustment for significant predictors including age, gender, ischaemic heart disease, hyperlipidaemia, hypertension, body mass index, glomerular filtration rate, serum urea, sodium, and haemoglobin levels demonstrated that patients with diabetes and IFG had a very similar outcome. Both were significant predictors of reduced survival compared with ‘normal’ glucose levels (fasting glucose levels between 92 and 99 mg/dL) [diabetes, hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.08–1.86, P = 0.01; IFG, HR 1.55, 95% CI 1.13–2.15, P < 0.01]. Diabetes and IFG were also predictors of increased cardiac‐related hospitalizations (diabetes HR 1.31, 95% CI 1.16–1.48, P < 0.001; IFG, HR 1.17, 95% CI 1.00–1.35, P < 0.05). Conclusions Diabetes and IFG are common in patients with HF and have a similar effect on outcome including survival and cardiac hospitalizations. Glucose abnormalities including subclinical diabetes confer significant risk in patients with HF.

Prognostic Impact of Diabetes on Long-term Survival Outcomes in Patients With Heart Failure: A Meta-analysis

“…The forest plot shown in Fig. 1 includes a total of 41 studies (12 RCTs [31,41,44,46,50,53,56,60,62,[65][66][67] and 29 observational registries [28,29,[32][33][34][35][36][37][38][39]42,43,45,48,49,51,52,54,55,[57][58][59]63,64,[68][69][70][71]73]) and provides the distribution of studies by estimate of the association between diabetes and the risk of all-cause death in 371,663 patients with HF (26.4% with diabetes), stratified by both HF subtype and study design.…”

“…Figure 4 shows the impact of diabetes per se on risk of the combined end point of allcause death or hospitalization. Nine studies (six RCTs [46,53,56,60,65,67] and three registries [39,47,58] As also shown in Fig. 4, when the analysis was restricted to the four eligible studies (i.e., three RCTs [46,53,67] and one observational registry [47]) that examined the combined end point of all-cause death or hospitalization for HF, patients with coexistent diabetes and chronic HF had a higher risk of the combined end point than those without diabetes (overall random-effects HR 1.54 [95% CI 1.28, 1.79]; I 2 = 84.6%).…”

Diabetes, impaired fasting glucose, and heart failure: Its not all about the sugar

“…The question remains, do IFG and diabetes differ in their relationship to outcomes? The work by Gotsman et al . suggests that IFG and diabetes impart the same risk of adverse outcomes in HF.…”

Soluble ST2 protein and hospitalizations due to worsening chronic heart failure during a one-year follow-up in a population with reduced ejection fraction

“…This is consistent with other studies showing an association between high concentrations of glucose and a worse prognosis in CHF. 29,30 In a study by Gotsman et al, impaired fasting glucose was a predictor of increased cardiac-related hospitalizations (HR 1.17, 95% CI 1.00-1.35, p < 0.05). 30 Recently more and more attention is being paid to the problem of hospitalization due to CHF decompensation, which means that identifying factors that affect its occurrence is very important.…”

“…29,30 In a study by Gotsman et al, impaired fasting glucose was a predictor of increased cardiac-related hospitalizations (HR 1.17, 95% CI 1.00-1.35, p < 0.05). 30 Recently more and more attention is being paid to the problem of hospitalization due to CHF decompensation, which means that identifying factors that affect its occurrence is very important. Reports of found new variables associated with hospitalization have been published, such as heart rate 31 , which was not a factor influencing hospitalization in the present study.…”