Abstract 3681: Diabetes And Incident Congestive Heart Failure
Background: There is growing evidence that diabetes is a cardiovascular (CV) disease, in addition to be an endocrine disturbance. Because congestive heart failure (CHF) is the terminal of many manifestations of CV disease, diabetes might be also directly responsible for CHF, a possibility that has little evidence, especially due to confounding coexistance of coronary heart diseese (CHD).
Methods: We evaluated 10-year incident CHF in 2890 participants free of prevalent CV disease at the 1st exam, from the cohort of the Strong Heart Study (1810 women). Diabetes, by ADA criteria, was present in 1216 individuals (DM, 42%), and impaired fasting glucose (IFG) in 424 (15%). Follow-up CHF was ascertained by an End-Point Commitee.
Results: DM had more frequently hypertension, central obesity (all p<0.0001) and the incidence of CHD was 2.2-fold greater (p<0.0001) than in non-diabetic participants (ND). During the 10-year follow-up, 59 cases of incident CHF were ascertained in normal glucose tolerance (NGT, 5%), 24 in IFG (5%) and 178 in DM (15%, OR=3.3 vs ND; p<0.0001). In a Cox model, DM maintained a 2.8-fold greater risk of CHF than NGT (95%CI: 2.0–3.8, p<0.0001), independently of age (p<0.003), sex, hypertension (p<0.02), central obesity, serum creatinine and incident coronary heart disease (HR=3.7, 95%CI: 2.8–4.8, p<0.0001), whereas no difference was found between NGT and IFG. After excluding 381 participants with incident coronary heart disease, DM confirmed a 3.3 fold hazard of CHF independent of the other covariates used in the model (figure⇓).
Conclusion: Diabetes is a strong, independent risk factor for CHF. Part of this effect is not mediated by incident coronary heart disease.