Diabetes and poor glycemic control increase HF risk in CAD patients

7 September 2010

MedWire News: Results from the Heart and Soul Study show that patients with stable coronary artery disease (CAD) who have diabetes are at increased risk for developing heart failure (HF) compared with nondiabetics with CAD.

The researchers also found that among those with diabetes, each 1% increase in the concentration of glycated hemoglobin (HbA1c) was associated with a 36% increase in relative risk for being hospitalized with HF.

Joost van Melle (University of Groningen, The Netherlands) and team enrolled 839 participants with stable CAD, but no history of HF. Of these, 200 (23.8%) had Type 2 diabetes.

The participants were followed up for a mean of 4.1 years for incidence of HF. The researchers found that those with diabetes at baseline had a significant 2.17-fold increased risk for developing HF over the study period compared with nondiabetics.

Adjustment for CAD risk factors, myocardial infarction in the interim, and myocardial ischemia did not significantly alter the association between diabetes and HF in these patients.

Following further adjustment for HF risk factors such as left ventricular ejection fraction, diastolic dysfunction, and C-reactive protein, as well as use of medication, the association grew stronger, with diabetic CAD patients having a significant 3.34-fold increased risk for HF compared with their nondiabetic peers.

Within the group with diabetes, higher levels of HbA1c were associated with increased HF risk, note the authors.

The Heart and Soul Study was set up to study longitudinal psychosocial factors and health outcomes in patients with stable CAD from the San Francisco area in the USA. van Melle and team excluded 185 patients from the original study cohort due to existing HF or unknown HF status.

Various theories have been suggested to explain the link between diabetes and HF. “In our study, the strength of the association between diabetes and HF did not attenuate after adjustment for established risk factors for HF, suggesting that traditional risk factors are not responsible for the detrimental association, giving fuel to the diabetic cardiomyopathy hypothesis,” conclude the investigators.

The results of this study are published in the journal Diabetes Care.

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Diabetes Care 2010; 33: 2084–2089