(Circulation. 2001;103:2668.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Glycemic Control and Heart Failure Among Adult Patients With Diabetes
Presented in part at the 73rd Scientific Sessions of the American Heart Association, New Orleans, La, November 12–15, 2000, and published in abstract form (Circulation. 2000;102[suppl II]:II-780).
From the Kaiser Permanente Division of Research, Oakland, Calif.
Correspondence to Carlos Iribarren, MD, MPH, PhD, Division of Research, The Permanente Medical Group, 3505 Broadway, Oakland, CA 94611. E-mail cgi{at}dor.kaiser.org
Background—Glycemic control is associated with microvascular events, but its effect on the risk of heart failure is not well understood. We examined the association between hemoglobin (Hb) AIc and the risk of heart failure hospitalization and/or death in a population-based sample of adult patients with diabetes and assessed whether this association differed by patient sex, heart failure pathogenesis, and hypertension status.
Methods and Results—A
cohort design was used with baseline between January 1, 1995, and June
30, 1996, and follow-up through December 31, 1997 (median 2.2 years).
Participants were 25 958 men and 22 900 women with (predominantly
type 2) diabetes, 
19 years old, with no known history of heart
failure. There were a total of 935 events (516 among men; 419 among
women). After adjustment for age, sex, race/ethnicity, education level,
cigarette smoking, alcohol consumption, hypertension, obesity, use of
ß-blockers and ACE inhibitors, type and duration of
diabetes, and incidence of interim myocardial infarction, each 1%
increase in Hb AIc was associated with an
8% increased risk of heart failure (95% CI 5% to 12%). An Hb
AIc 10, relative to Hb
AIc <7, was associated with 1.56-fold (95% CI
1.26 to 1.93) greater risk of heart failure. Although the association
was stronger in men than in women, no differences existed by heart
failure pathogenesis or hypertension
status.
Conclusions—These results confirm previous evidence that poor glycemic control may be associated with an increased risk of heart failure among adult patients with diabetes.
Key Words: heart failure • diabetes mellitus • glycemia • hemoglobin
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