Abstract 2562: Fasting Plasma Glucose is an Independent Predictor of Hospitalization for Congestive Heart Failure in High-Risk Patients
Background: Patients with established diabetes mellitus have increased risk of congestive heart failure (CHF).Whether plasma glucose is independently related to risk, or just a marker is unknown. Purpose: To evaluate the associations between fasting plasma glucose (FPG) and the risk of hospitalization for CHF, in high-risk patients without symptomatic CHF enrolled in a large prospective clinical trial.
Methods and patients: Baseline FPG was assessed in 31 546 high-risk subjects with coronary, peripheral, cerebrovascular disease or with DM with end-organ damage participating in two ongoing parallel trials evaluating the effects of telmisartan, ramipril or the combination (ONTARGET, n=25 620) and the effects of telmisartan vs placebo in ACE-intolerant patients (TRANSCEND, n=5926). We performed an interim analysis, blinded for randomized treatment, comparing baseline FPG to the adjusted CHF event rate at a mean follow-up of 886 days.
Results: Of all subjects (mean 67 years; 69% men), 11 708/31 546 patients (37%) had known DM and 1006 (3.2%) patients were diagnosed with DM at baseline. During follow-up, 668 patients were hospitalized for CHF. Evaluating glucose as a continuous variable, a 1 mmol/L rise in FPG was related to an increased risk of hospitalization for CHF (RR=1.10; 95% CI 1.08 –1.12; p<0.0001 after age and sex adjustments). After multivariate adjustments (age, sex, smoking, previous MI, HT, waist-hip ratio, diabetes, medication with aspirin, beta-blockers and statins) the risk was still significantly increased (RR=1.05; 95% CI 1.02–1.08; p<0.001).
Conclusion: Fasting plasma glucose is an independent predictor of hospitalization for CHF, even after adjustment for established risk factors, including diabetes. This suggests that glucose is more than just a marker of diabetes and may play a causal role in the development of CHF events.