The Association Between Glucose Abnormalities and Heart Failure in the Population-Based Reykjavík Study

Abstract

OBJECTIVE -Diabetes is an independent risk factor for heart failure, whereas the relation between heart failure and abnormal glucose regulation (AGR) needs further evaluation. We studied this combination in the Reykjavík Study. RESEARCH DESIGN AND METHODS -The ReykjavíkStudy, a population-based cohort study during 1967-1997, recruited 19,381 participants aged 33-84 years who were followed until 2002. Oral glucose tolerance tests and chest X-rays were obtained from all participants. Cases were defined in accordance with World Health Organization criteria for type 2 diabetes or AGR (impaired glucose tolerance or impaired fasting glucose) and European Society of Cardiology guidelines for heart failure.RESULTS -The overall prevalence of type 2 diabetes and heart failure was 0.5% in men and 0.4% in women, while AGR and heart failure were found in 0.7% of men and 0.6% of women. Among participants with normal glucose regulation, heart failure was diagnosed in 3.2% compared with 6.0 and 11.8% among those with AGR and type 2 diabetes, respectively. The prevalence of type 2 diabetes in the age-group 45-65 years increased in both sexes during the period (P for trend ϭ 0.007). The odds ratio was 2.8 (95% CI 2.2-3.6) for the association between type 2 diabetes and heart failure and 1.7 (1.4 -2.1) between AGR and heart failure.CONCLUSIONS -There is a strong association between any form of glucometabolic perturbation and heart failure. Future studies in this field should focus on all types of glucose abnormalities rather than previously diagnosed diabetes only. Diabetes Care 28:612-616, 2005T ype 2 diabetes, a disease of increasing prevalence, is a risk factor for heart failure (1,2). Poor glucometabolic control, as reflected by a high HbA 1c , increases the risk of developing heart failure (3). Diabetic patients are more prone to develop heart failure during an ischemic event, despite comparable size of myocardial injury, and their prognosis is more unfavorable than that in nondiabetic patients (4).The prevalence of heart failure combined with diabetes was 10 and 15%, respectively, among elderly Italians. Moreover, a higher proportion of patients with than without heart failure developed diabetes over time (5). Although there are reports on the relationship of either diabetes or impaired glucose tolerance and heart failure (6,7), the association of the total spectrum of glucose abnormalities and heart failure, as well as the prevalence and risk factors for heart failure, has, to our knowledge, not been studied in a large epidemiological study.The Reykjavík Study is a populationbased study that included glucose tolerance tests for almost every participant. The present study reports on the prevalence of glucose abnormalities and heart failure and their combination in this population. RESEARCH DESIGN AND METHODS -All inhabitants in theReykjavík metropolitan area at 1 December 1966 and born 1907-1935 were invited to participate in the study, as previously reported (8). Those who participated (n ϭ 19,381) were divided into groups ...

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

“…Studies in heart failure populations reveal a prevalence of T2DM from 12-30%, rising with age. 270,271 In the Framingham study, the age-adjusted relative risk of heart failure in patients with T2DM (age 45-74 years) was 2.2 for men and 5.3 for women. 272 The high incidence of heart failure in patients with T2DM was confirmed in the National Health and Nutrition Examination Survey, with an HR of 1.85 (95% CI 1.51-2.28) in T2DM compared with non-DM.…”

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

“…In the Reykjavik study, IGT was shown to be an independent predictor of all-cause mortality to a similar degree to that of DM 36 . In a recent study carried out in Division of Cardiology, Department of Medicine, Kameda Medical Center, Chiba, Japan, it was shown that HF patients with IGT tended to have a higher mortality rate than those without glucose intolerance 28 .…”

“…This was possibly from the fact that we only included the hospitalized heart failure subjects and in-hospital outcome was based on mortality and length of hospital stay whereas, in other studies they included both inpatient and outpatient department and long term cohort study was done there. The diagnosis of IGT & IFG in the Reykjavik study, however, was done on 50 gm OGTT, not 75 gm was used in the present study 36 . The European Guidelines on diabetes, prediabetes, and cardiovascular diseases recommend use of 75-g OGTT 38 .…”

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

“…Approximately 12% of diabetes mellitus patients have heart failure (54), and over the age of 64 years, the prevalence increases to 22% (56). 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).…”

“…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). In population and clinical trial studies (62-68), heart failure patients with diabetes mellitus have greater mortality rates than those without, and diabetes mellitus is an independent predictor of mortality in heart failure patients.…”