Impaired glucose tolerance and albuminuria in patients with chronic heart failure: a subanalysis of the SUPPORT trial

Nochioka, Kotaro; Sakata, Yasuhiko; Miura, Masanobu; Shiroto, Takashi; Takahashi, Jun; Saga, Chie; Ikeno, Yasuko; Shiba, Nobuyuki; Shinozaki, Tsuyoshi; Sugi, Masafumi; Nakagawa, Makoto; Komaru, Tatsuya; Kato, Atsushi; Nozaki, Eiji; Iwabuchi, Kaoru; Hiramoto, Tetsuya; Inoue, Koetsu; Ohe, Masatoshi; Tamaki, Kenji; Tsuji, Ichiro; Shimokawa, Hiroaki

doi:10.1002/ehf2.12516

Cited by 5 publications

(7 citation statements)

References 36 publications

(74 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…18 Second, in patients with HF with prediabetes, further However, in those without albuminuria, the risk of mortality was similar in those with IGT or normoglycaemia. 17 Third, our results emphasized the importance of better understanding of the role across a broader range of glucometabolic abnormalities in HF, achieving timely and effective prevention of adverse outcomes. Optimal management of prediabetes in HF remains to be defined.…”

Section: Discussionmentioning

confidence: 79%

See 1 more Smart Citation

Association between prediabetes and adverse outcomes in heart failure

Mai

Wen

Qiu

et al. 2021

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

Aims Patients with heart failure (HF) and with diabetes experienced significantly worse outcomes than those without diabetes. However, data on the prognostic impact of prediabetes in HF are inconclusive. This meta‐analysis aimed to explore the association between prediabetes and the risk of all‐cause mortality and adverse cardiac outcomes in patients with HF. Materials and methods We searched multiple electronic databases (PubMed, Embase and Google Scholar) for relevant studies up to 31 March 2021. Studies were included for analysis if multivariable adjusted relative risks of adverse outcomes were reported in patients with prediabetes and with HF compared with those with normoglycaemia. Random‐effects models were used to calculate the pooled hazard ratios (HRs) and 95% confidence intervals (CIs). Results Twelve studies comprising 28 643 patients with HF reported the risk of all‐cause mortality and cardiac outcomes associated with prediabetes. The prevalence of prediabetes ranged from 9.6% to 37.2%. After a median follow‐up duration of 2.3 years, patients with HF and with prediabetes were associated with an increased risk of all‐cause mortality (HR 1.29, 95% CI 1.06‐1.58), cardiovascular mortality (HR 1.59, 95% CI 1.09‐2.32), HF hospitalization (HR 1.33, 95% CI 1.09‐1.61), all‐cause mortality and/or HF hospitalization (HR 1.22, 95% CI 1.01‐1.47), as well as cardiovascular mortality and/or HF hospitalization (HR 1.21, 95% CI 1.07‐1.37). Conclusions Prediabetes is associated with a worse prognosis in patients with HF. Further risk stratification and effective treatment strategies are needed in patients with prediabetes and with HF to improve the prognosis.

show abstract

Section: Discussionmentioning

confidence: 79%

“…13,14 However, whether prediabetes is associated with a worse prognosis in patients with HF remains unclear. [15][16][17][18] Therefore, in this meta-analysis, we aimed to answer the following question: in patients with established HF, does coexisting prediabetes confer a worse prognosis than in those with normoglycaemia?…”

mentioning

confidence: 99%

Association between prediabetes and adverse outcomes in heart failure

Mai

Wen

Qiu

et al. 2021

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

show abstract

“…Diabetic microangiopathy is associated with an increased risk of HF and can be assessed by using the urine albumin-to-urine creatinine ratio (uACR). It has been demonstrated that albuminuria was closely related to the occurrence, development, and prognosis of CHD and HF [7][8][9][10]. A community-based study also confirmed that the risk of HF was increased by 54-91% with a mild increase in uACR [11].…”

Section: Introductionmentioning

confidence: 81%

Elevated urine albumin-to-creatinine ratio increases the risk of new-onset heart failure in patients with type 2 diabetes

Tao

Sang²,

Zhen³

et al. 2023

Cardiovasc Diabetol

View full text Add to dashboard Cite

Background Although albuminuria has been linked to heart failure in the general population, the relationship between urine albumin-to-creatinine ratio (uACR) and heart failure in type 2 diabetes patients is not well understood. We aimed to investigate the relationship between uACR and new-onset heart failure (HF) in type 2 diabetics. Methods We included 9287 Chinese participants with type 2 diabetes (T2D) but no heart failure (HF) who were assessed with uACR between 2014 and 2016. The participants were divided into three groups based on their baseline uACR: normal (< 3 mg/mmol), microalbuminuria (3–30 mg/mmol), and macroalbuminuria (≥ 30 mg/mmol). The relationship between uACR and new-onset HF was studied using Cox proportional hazard models and restricted cubic spline. The area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to see if incorporating uACR into existing models could improve performance. Results 216 new-onset HF cases (2.33%) were recorded after a median follow-up of 4.05 years. When compared to normal uACR, elevated uACR was associated with a progressively increased risk of new-onset HF, ranging from microalbuminuria (adjusted HR, 2.21; 95% CI 1.59–3.06) to macroalbuminuria (adjusted HR, 6.02; 95% CI 4.11–8.80), and 1 standard deviation (SD) in ln (uACR) (adjusted HR, 1.89; 95% CI 1.68–2.13). The results were consistent across sex, estimated glomerular filtration rate, systolic blood pressure, and glycosylated hemoglobin subgroups. The addition of uACR to established HF risk models improved the HF risk prediction efficacy. Conclusions Increasing uACR, even below the normal range, is an independent risk factor for new-onset HF in a type 2 diabetic population. Furthermore, uACR may improve HF risk prediction in community-based T2D patients.

show abstract

“…In a series of 227 HFrEF patients who had an OGTT, 23% were classified as having IGT and 18% as having newly diagnosed diabetes, and similar percentages were found in patients with either ischemic or non-ischemic HF [ 7 ]. In a subanalysis of the SUPPORT trial including 535 HF patients without known diabetes (18% with HFrEF and 62% with HFpEF), IGT was found in 23% of those participants [ 32 ]. However, there was no published study comparing adequately the prevalence of newly diagnosed glucose disorders in HFrEF and HFpEF patients.…”

Section: Discussionmentioning

confidence: 99%

Prediabetes and insulin resistance in a population of patients with heart failure and reduced or preserved ejection fraction but without diabetes, overweight or hypertension

Son

Toan

Thang

et al. 2022

Cardiovasc Diabetol

View full text Add to dashboard Cite

Background The relationships between glucose abnormalities, insulin resistance (IR) and heart failure (HF) are unclear, especially regarding to the HF type, i.e., HF with reduced (HFrEF) or preserved (HFpEF) ejection fraction. Overweight, diabetes and hypertension are potential contributors to IR in persons with HF. This study aimed to evaluate the prevalence of prediabetes and IR in a population of Vietnamese patients with HFrEF or HFpEF but no overweight, diabetes or hypertension, in comparison with healthy controls, and the relation between prediabetes or IR and HF severity. Methods We conducted a prospective cross-sectional observational study in 190 non-overweight normotensive HF patients (114 with HFrEF and 76 with HFpEF, 92.6% were ischemic HF, mean age was 70.1 years, mean BMI 19.7 kg/m2) without diabetes (neither known diabetes nor newly diagnosed by OGTT) and 95 healthy individuals (controls). Prediabetes was defined using 2006 WHO criteria. Glucose and insulin levels were measured fasting and 2 h after glucose challenge. IR was assessed using HOMA-IR and several other indexes. Results Compared to controls, HF patients had a higher prevalence of prediabetes (63.2% vs 22.1%) and IR (according to HOMA-IR, 55.3% vs 26.3%), higher HOMA-IR, insulin/glucose ratio after glucose and FIRI, and lower ISIT0 and ISIT120 (< 0.0001 for all comparisons), with no difference for body weight, waist circumference, blood pressure and lipid parameters. Prediabetes was more prevalent (69.3% vs 53.9%, p = 0.03) and HOMA-IR was higher (p < 0.0001) in patients with HFrEF than with HFpEF. Among both HFrEF and HFpEF patients, those with prediabetes or IR had a more severe HF (higher NYHA functional class and NT-proBNP levels, lower ejection fraction; p = 0.04–< 0.0001) than their normoglycemic or non-insulinresistant counterparts, with no difference for blood pressure and lipid parameters. Conclusion In non-diabetic non-overweight normotensive patients with HF, the prevalence of prediabetes is higher with some trend to more severe IR in those with HFrEF than in those with HFpEF. Both prediabetes and IR are associated with a more severe HF. The present data support HF as a culprit for IR. Intervention strategies should be proposed to HF patients with prediabetes aiming to reduce the risk of incident diabetes. Studies should be designed to test whether such strategies may translate into an improvement of further HF-related outcomes.

show abstract

Impaired glucose tolerance and albuminuria in patients with chronic heart failure: a subanalysis of the SUPPORT trial

Cited by 5 publications

References 36 publications

Association between prediabetes and adverse outcomes in heart failure

Association between prediabetes and adverse outcomes in heart failure

Elevated urine albumin-to-creatinine ratio increases the risk of new-onset heart failure in patients with type 2 diabetes

Prediabetes and insulin resistance in a population of patients with heart failure and reduced or preserved ejection fraction but without diabetes, overweight or hypertension

Contact Info

Product

Resources

About