Abstract 18596: Low Fasting Plasma Glucose is Associated With Increased Mortality in Patients With Advanced Heart Failure: “Fasting Glucose Paradox"
Introduction: Glucose homeostasis is often abnormal in advanced heart failure (HF). Epidemiology studies suggested U-shape relation between fasting plasma glucose (FPG) and mortality in general population, but determinants and implications of abnormal FPG in advanced HF are not known.
Hypothesis: We hypothesized that plasma glucose and glucose-regulating hormones are associated with prognosis in advanced HF.
Methods: We examined 141 advanced HFrEF patients without known diabetes (DM) (age 54±6 y, NYHA 2.8±0.6, BMI 28±2kg.m-2, BNP 935±938 pg.ml-1) and 21 gender, age, BMI and fat mass- matched controls. Subjects underwent body composition assessment (DEXA), oral glucose tolerance test (OGT, 75g glucose, 2h) and longitudinal follow-up to analyze the relation to outcome (Cox model, endpoint: death/LVAD/urgent Tx).
Results: Compared to controls, HF patients had similar FPG and insulin, but markedly abnormal post-OGT glucose, insulin and C-peptide. HF patients had increased HbA1C (44±5.8 vs 38±3.1 mmol.mol-1) and based on OGT, 20% had latent DM. After 424 (IQR: 134-1500) days of follow-up, 42% experienced adverse event. Interestingly, FPG, but not post-OGT parameters or DM status, displayed strong relation to outcome. Low glucose, low insulin and increased glucagon were associated with increased risk (Figure). Patients in the lowest FPG quartile (3.8-5.1 mmol/l) had 3.1-time higher event risk than the patients in the highest FPG quartile (6.0-7.9 mmol/l) (p=0.01). In HF, but not in controls, FPG correlated with total body fat mass (r=0.4, p<0.001) and inversely with log-BNP (r=-0.32, p<0.001), but not with lean mass, liver or kidney function. In multivariate model, only total body fat and glucagon (but not FPG, insulin or C-peptide) independently predicted the outcome.
Conclusions: In advanced HF patients without DM therapy, low-normal FPG is paradoxically associated with poorer survival. Low FPG reflects primarily body fat mass depletion.
Author Disclosures: V. Melenovsky: None. M. Segetova: None. J. Benes: None. P. Stavek: None. J. Kovar: None. T. Pelikanova: None.
- © 2016 by American Heart Association, Inc.