Marco Dauriz1, Giovanni Targher1, Cécile Laroche2, Pier Luigi Temporelli3, Roberto Ferrari4, Stephan Anker5, Andrew Coats6,7, Gerasimos Filippatos8, Maria Crespo-Leiro9, Alexandre Mebazaa10, Massimo F Piepoli11, Aldo P Maggioni12,13, Luigi Tavazzi4,14. 1. Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy. 2. EURObservational Research Programme, European Society of Cardiology, Sophia Antipolis, France. 3. Division of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Salvatore Maugeri, Veruno, Italy. 4. Department of Cardiology and Industrial Research and Technology Transfer Laboratory Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy. 5. Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Center Göttingen, Göttingen, Germany. 6. Monash University, Melbourne, Victoria, Australia. 7. University of Warwick, Coventry, U.K. 8. Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain. 9. Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruña, La Coruña, Spain. 10. INSERM 942, Hôpital Lariboisière, Université Paris Diderot, Paris, France. 11. Department of Cardiology, Polichirurgico Hospital G. da Saliceto, Piacenza, Italy. 12. EURObservational Research Programme, European Society of Cardiology, Sophia Antipolis, France amaggioni@escardio.org. 13. ANMCO Research Center, Florence, Italy. 14. Department of Cardiology and Industrial Research and Technology Transfer Laboratory Centre, University Hospital of Ferrara, Ferrara, Italy.
Abstract
OBJECTIVE: Diabetes mellitus is associated with an increased risk of cardiovascular disease (CVD) and death. Because the prevalence of diabetes is rising worldwide and chronic heart failure (CHF) is becoming increasingly common with the aging population, it is timely to examine the impact of diabetes per se on 1-year adverse outcomes in patients with CHF. RESEARCH DESIGN AND METHODS: We prospectively assessed whether diabetes status independently affected the 1-year risk of all-cause and CVD mortality and first hospitalization for worsening heart failure (HF) in a multinational cohort of 9,428 outpatients with CHF enrolled in the European Society of Cardiology and Heart Failure Association Long-Term Registry. RESULTS: Compared with those patients without diabetes, patients with diabetes (n = 3,440, 36.5%) had higher cumulative rates of 1-year all-cause death (9.4% vs. 7.2%; adjusted hazard ratio [HR] 1.28; 95% CI 1.07-1.54), CVD death (4.8% vs. 3.8%; adjusted HR 1.28; 95% CI 0.99-1.66), and HF hospitalization (13.8% vs. 9.3%; adjusted HR 1.37; 95% CI 1.17-1.60), all independent of age, sex, BMI, smoking, systolic blood pressure, estimated glomerular filtration rate, hemoglobin, HF etiology, left ventricular ejection fraction, hypertension, statin use, and prior stroke or chronic obstructive pulmonary disease. Among CHF patients with HbA1c measurements available at baseline (n = 2,567), there was a significant and independent association between increasing HbA1c levels and the risk of 1-year survival outcomes. CONCLUSIONS: The presence of diabetes markedly increases the risk of 1-year adverse clinical outcomes in outpatients with CHF independent of multiple common risk factors. More effective and personalized treatment for diabetes should be considered in this particularly high-risk patient population.
OBJECTIVE:Diabetes mellitus is associated with an increased risk of cardiovascular disease (CVD) and death. Because the prevalence of diabetes is rising worldwide and chronic heart failure (CHF) is becoming increasingly common with the aging population, it is timely to examine the impact of diabetes per se on 1-year adverse outcomes in patients with CHF. RESEARCH DESIGN AND METHODS: We prospectively assessed whether diabetes status independently affected the 1-year risk of all-cause and CVD mortality and first hospitalization for worsening heart failure (HF) in a multinational cohort of 9,428 outpatients with CHF enrolled in the European Society of Cardiology and Heart Failure Association Long-Term Registry. RESULTS: Compared with those patients without diabetes, patients with diabetes (n = 3,440, 36.5%) had higher cumulative rates of 1-year all-cause death (9.4% vs. 7.2%; adjusted hazard ratio [HR] 1.28; 95% CI 1.07-1.54), CVD death (4.8% vs. 3.8%; adjusted HR 1.28; 95% CI 0.99-1.66), and HF hospitalization (13.8% vs. 9.3%; adjusted HR 1.37; 95% CI 1.17-1.60), all independent of age, sex, BMI, smoking, systolic blood pressure, estimated glomerular filtration rate, hemoglobin, HF etiology, left ventricular ejection fraction, hypertension, statin use, and prior stroke or chronic obstructive pulmonary disease. Among CHFpatients with HbA1c measurements available at baseline (n = 2,567), there was a significant and independent association between increasing HbA1c levels and the risk of 1-year survival outcomes. CONCLUSIONS: The presence of diabetes markedly increases the risk of 1-year adverse clinical outcomes in outpatients with CHF independent of multiple common risk factors. More effective and personalized treatment for diabetes should be considered in this particularly high-risk patient population.