What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure (n=136). Intervention: Impaired glucose tolerance (IGT) vs. Normal glucose tolerance (NGT). Primary outcome: Major adverse cardiac and cerebrovascular events (MACCE) (HR 4.51, 95% CI 1.41-14.47, p=0.011).

January 1, 2011Circulation Journal62 citationsOpen Access

Prevalence and Prognostic Implications of Pre-Diabetic State in Patients With Heart Failure

YMYuya MatsueHeart Failure / Cardiomyopathy MSMakoto SuzukiNihon University RNRena NakamuraTokyo Yamate Medical Center

Key Result

Impaired glucose tolerance independently predicted major adverse cardiac and cerebrovascular events in patients with heart failure, increasing the risk by over 4-fold (HR 4.51) compared to normal glucose tolerance.

Study Design

Type

Cohort (n=136)

Multicenter

Structured PICO

Does impaired glucose tolerance or diabetes mellitus increase the risk of major adverse cardiac and cerebrovascular events in patients with heart failure?

Population

136 patients admitted with congestive heart failure, followed for a median of 150 days to assess the prognostic impact of glucose intolerance.

Exposure

Impaired glucose tolerance (IGT) or Diabetes Mellitus (DM) diagnosed via 75-g oral glucose tolerance test (OGTT) or prior history

Comparator

Normal glucose tolerance (NGT)

Outcome

Major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of death from cardiac causes, non-fatal myocardial infarction, unstable angina, rehospitalization because of congestive HF, and cerebral infarctioncomposite

Impaired glucose tolerance and diabetes mellitus, but not impaired fasting glucose, are independent predictors of adverse cardiovascular events in patients with heart failure.

Main Result

Hazard Ratio: 4.51 (95% CI 1.41–14.47)

Absolute Event Rate: 31.6% vs 11.8%

p-value: p=0.011

Limitations

Small number of patients at a single center
Included only patients with HF who required hospitalization, limiting extrapolation to the whole HF population
Did not evaluate diastolic function on echocardiography due to a considerable number of patients with atrial fibrillation
Presence or absence of glucose intolerance and need for admission were determined by the attending physician, which may have affected readmission rates
Included only patients with HF who required hospitalization
Did not evaluate diastolic function on echocardiography due to high prevalence of atrial fibrillation
Attending physician determined presence or absence of glucose intolerance and readmission

Abstract

BACKGROUND: Diabetes mellitus (DM) is a risk factor of poor prognosis in patients with heart failure (HF). The prevalence and prognostic impact of the pre-diabetic state, however, are not well understood. METHODS AND RESULTS: One hundred and thirty-six consecutive patients admitted due to HF were included in this prospective study. The 75-g oral glucose tolerance test (OGTT) was performed in all patients without known DM, and patients were classified into normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and DM groups. Forty-two of the 136 patients had previously been diagnosed with diabetes. Of the remaining 94 patients without known diabetes, 35 (37.2%) patients were classified as NGT, 9 (9.6%) as having IFG, 37 (39.4%) were classified as having IGT, and 13 (13.8%) were newly diagnosed with DM. During follow-up, patients with DM or IGT had significantly lower major adverse cardiac and cerebrovascular event (MACCE)-free rates than NGT patients (P=0.006, P=0.036, respectively). IFG, however, was not significantly related to increased MACCE risk. The presence of IGT (hazard ratio HR, 4.51; P=0.011) and DM (HR, 4.74; P=0.005) were independent predictors of MACCE even after multivariate analysis. CONCLUSIONS: IGT and DM contribute to adverse prognosis in patients with HF. It is feasible to perform diabetes screening using OGTT in patients with HF for risk stratification.

Ask AI

Helpful

Bookmark

View Full Paper