Diabetes in Heart Failure: Prevalence and Impact on Outcome in the Population

Aaron M. From, Cynthia L. Leibson, Francesca Bursi, Margaret May Redfield, Susan A. Weston, Steven J. Jacobsen, Richard J. Rodeheffer, Veronique Lee Roger

Research output: Contribution to journalArticle

169 Citations (Scopus)

Abstract

Purpose: Little is known on the prevalence and prognostic importance of diabetes mellitus (DM) among individuals with heart failure (HF) in community-based cohorts. Methods: Within Olmsted County, Minnesota, a random sample of all subjects with a first diagnosis of HF between 1979 and 1999 was validated using Framingham criteria. DM was validated using glycemic criteria. Results: Among 665 subjects with HF (mean age 77 ± 12 years, 46% male), 20% had prior DM. Subjects with DM were younger, had greater body mass index (BMI), and lower left ventricular ejection fraction than subjects without diabetes. The prevalence of DM increased markedly over time (3.8% per year; 95% confidence interval [CI], 0.8 to 6.9; P = .024), independently of BMI, particularly in older subjects (odds ratio of having DM in 1999 compared with 1979 was 3.93 [95% CI, 1.57 to 9.83] in subjects ≥75 years vs. 1.11 [95% CI, .40 to 3.05] in subjects <75 years). Five-year survival was 37% among subjects with DM versus 46% among subjects without (P = .017). The risk of death associated with DM differed markedly according to clinical coronary artery disease (CAD) (P = .025). Subjects with DM and no CAD had a higher risk of death (relative risk [RR] = 1.79 [95% CI, 1.33 to 2.41]) than those with CAD (RR = 1.11 [95% CI, .81 to 1.51]), independently of age, sex, BMI, renal function, calendar year of HF, comorbidity and EF. Conclusions: Among community-dwelling patients with HF, the prevalence of DM increased markedly over time. DM is associated with a large increase in mortality, particularly among subjects without clinical CAD, underscoring the importance of aggressive management of DM in HF.

Original languageEnglish (US)
Pages (from-to)591-599
Number of pages9
JournalAmerican Journal of Medicine
Volume119
Issue number7
DOIs
StatePublished - Jul 2006

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Diabetes Mellitus
Heart Failure
Population
Confidence Intervals
Coronary Artery Disease
Body Mass Index
Independent Living
Stroke Volume
Comorbidity
Odds Ratio
Kidney
Survival
Mortality

Keywords

  • Coronary disease
  • Diabetes mellitus
  • Heart failure

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Diabetes in Heart Failure : Prevalence and Impact on Outcome in the Population. / From, Aaron M.; Leibson, Cynthia L.; Bursi, Francesca; Redfield, Margaret May; Weston, Susan A.; Jacobsen, Steven J.; Rodeheffer, Richard J.; Roger, Veronique Lee.

In: American Journal of Medicine, Vol. 119, No. 7, 07.2006, p. 591-599.

Research output: Contribution to journalArticle

From, Aaron M. ; Leibson, Cynthia L. ; Bursi, Francesca ; Redfield, Margaret May ; Weston, Susan A. ; Jacobsen, Steven J. ; Rodeheffer, Richard J. ; Roger, Veronique Lee. / Diabetes in Heart Failure : Prevalence and Impact on Outcome in the Population. In: American Journal of Medicine. 2006 ; Vol. 119, No. 7. pp. 591-599.
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abstract = "Purpose: Little is known on the prevalence and prognostic importance of diabetes mellitus (DM) among individuals with heart failure (HF) in community-based cohorts. Methods: Within Olmsted County, Minnesota, a random sample of all subjects with a first diagnosis of HF between 1979 and 1999 was validated using Framingham criteria. DM was validated using glycemic criteria. Results: Among 665 subjects with HF (mean age 77 ± 12 years, 46{\%} male), 20{\%} had prior DM. Subjects with DM were younger, had greater body mass index (BMI), and lower left ventricular ejection fraction than subjects without diabetes. The prevalence of DM increased markedly over time (3.8{\%} per year; 95{\%} confidence interval [CI], 0.8 to 6.9; P = .024), independently of BMI, particularly in older subjects (odds ratio of having DM in 1999 compared with 1979 was 3.93 [95{\%} CI, 1.57 to 9.83] in subjects ≥75 years vs. 1.11 [95{\%} CI, .40 to 3.05] in subjects <75 years). Five-year survival was 37{\%} among subjects with DM versus 46{\%} among subjects without (P = .017). The risk of death associated with DM differed markedly according to clinical coronary artery disease (CAD) (P = .025). Subjects with DM and no CAD had a higher risk of death (relative risk [RR] = 1.79 [95{\%} CI, 1.33 to 2.41]) than those with CAD (RR = 1.11 [95{\%} CI, .81 to 1.51]), independently of age, sex, BMI, renal function, calendar year of HF, comorbidity and EF. Conclusions: Among community-dwelling patients with HF, the prevalence of DM increased markedly over time. DM is associated with a large increase in mortality, particularly among subjects without clinical CAD, underscoring the importance of aggressive management of DM in HF.",
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T1 - Diabetes in Heart Failure

T2 - Prevalence and Impact on Outcome in the Population

AU - From, Aaron M.

AU - Leibson, Cynthia L.

AU - Bursi, Francesca

AU - Redfield, Margaret May

AU - Weston, Susan A.

AU - Jacobsen, Steven J.

AU - Rodeheffer, Richard J.

AU - Roger, Veronique Lee

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N2 - Purpose: Little is known on the prevalence and prognostic importance of diabetes mellitus (DM) among individuals with heart failure (HF) in community-based cohorts. Methods: Within Olmsted County, Minnesota, a random sample of all subjects with a first diagnosis of HF between 1979 and 1999 was validated using Framingham criteria. DM was validated using glycemic criteria. Results: Among 665 subjects with HF (mean age 77 ± 12 years, 46% male), 20% had prior DM. Subjects with DM were younger, had greater body mass index (BMI), and lower left ventricular ejection fraction than subjects without diabetes. The prevalence of DM increased markedly over time (3.8% per year; 95% confidence interval [CI], 0.8 to 6.9; P = .024), independently of BMI, particularly in older subjects (odds ratio of having DM in 1999 compared with 1979 was 3.93 [95% CI, 1.57 to 9.83] in subjects ≥75 years vs. 1.11 [95% CI, .40 to 3.05] in subjects <75 years). Five-year survival was 37% among subjects with DM versus 46% among subjects without (P = .017). The risk of death associated with DM differed markedly according to clinical coronary artery disease (CAD) (P = .025). Subjects with DM and no CAD had a higher risk of death (relative risk [RR] = 1.79 [95% CI, 1.33 to 2.41]) than those with CAD (RR = 1.11 [95% CI, .81 to 1.51]), independently of age, sex, BMI, renal function, calendar year of HF, comorbidity and EF. Conclusions: Among community-dwelling patients with HF, the prevalence of DM increased markedly over time. DM is associated with a large increase in mortality, particularly among subjects without clinical CAD, underscoring the importance of aggressive management of DM in HF.

AB - Purpose: Little is known on the prevalence and prognostic importance of diabetes mellitus (DM) among individuals with heart failure (HF) in community-based cohorts. Methods: Within Olmsted County, Minnesota, a random sample of all subjects with a first diagnosis of HF between 1979 and 1999 was validated using Framingham criteria. DM was validated using glycemic criteria. Results: Among 665 subjects with HF (mean age 77 ± 12 years, 46% male), 20% had prior DM. Subjects with DM were younger, had greater body mass index (BMI), and lower left ventricular ejection fraction than subjects without diabetes. The prevalence of DM increased markedly over time (3.8% per year; 95% confidence interval [CI], 0.8 to 6.9; P = .024), independently of BMI, particularly in older subjects (odds ratio of having DM in 1999 compared with 1979 was 3.93 [95% CI, 1.57 to 9.83] in subjects ≥75 years vs. 1.11 [95% CI, .40 to 3.05] in subjects <75 years). Five-year survival was 37% among subjects with DM versus 46% among subjects without (P = .017). The risk of death associated with DM differed markedly according to clinical coronary artery disease (CAD) (P = .025). Subjects with DM and no CAD had a higher risk of death (relative risk [RR] = 1.79 [95% CI, 1.33 to 2.41]) than those with CAD (RR = 1.11 [95% CI, .81 to 1.51]), independently of age, sex, BMI, renal function, calendar year of HF, comorbidity and EF. Conclusions: Among community-dwelling patients with HF, the prevalence of DM increased markedly over time. DM is associated with a large increase in mortality, particularly among subjects without clinical CAD, underscoring the importance of aggressive management of DM in HF.

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