HbA1c as a risk factor for heart failure in persons with diabetes: the Atherosclerosis Risk in Communities (ARIC) study
Open accessAbstract
Aims/hypothesis Heart failure (HF) incidence in diabetes in both the presence and absence of CHD is rising. Prospective population-based studies can help describe the relationship between HbA(1c), a measure of glycaemia control, and HF risk.Methods We studied the incidence of HF hospitalisation or death among 1,827 participants in the Atherosclerosis Risk in Communities (ARIC) study with diabetes and no evidence of HF at baseline. Cox proportional hazard models included age, sex, race, education, health insurance status, alcohol consumption, BMI and WHR, and major CHD risk factors (BP level and medications, LDL- and HDL-cholesterol levels, and smoking).Results In this population of persons with diabetes, crude HF incidence rates per 1,000 person-years were lower in the absence of CHD (incidence rate 15.5 for CHD-negative vs 56.4 for CHD-positive, p<0.001). The adjusted HR of HF for each 1% higher HbA(1c) was 1.17 (95% CI 1.11-1.25) for the non-CHD group and 1.20 (95% CI 1.04-1.40) for the CHD group. When the analysis was limited to HF cases which occurred in the absence of prevalent or incident CHD (during follow-up) the adjusted HR remained 1.20 (95% CI 1.11-1.29).Conclusions/interpretations These data suggest HbA(1c) is an independent risk factor for incident HF in persons with diabetes with and without CHD. Long-term clinical trials of tight glycaemic control should quantify the impact of different treatment regimens on HF risk reduction.
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In observational studies (NHANES and ARIC), the incidence of HF in patients with T2DM was higher than in those without T2DM, with hazard ratios of 1.85 and 3.54.
“Similarly, in observational studies (NHANES 64 and ARIC 65 ), the incidence of HF in patients with T2DM was higher than in those without T2DM, with the corresponding hazard ratios (HRs) of 1.85 and 3.54.”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [65]
In the ARIC study, higher HbA1c levels in T2DM patients were associated with significantly more incident HF cases than in patients with T2DM and lower HbA1c levels.
“Indeed, in the ARIC study, higher HbA 1c levels in T2DM patients were associated with significantly more incident HF cases than in patients with T2DM and lower HbA 1c levels.65”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [65]
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- Authors
- Pazin-Filho, A., Kottgen, A., Bertoni, A. G., Russell, S. D., Selvin, E., Rosamond, W. D., & Coresh, J.
- Affiliations
- Wake Forest University Health Sciences (US)
- Johns Hopkins University (US)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Coresh, J.
- Venue
- Diabetologia
- Published
- 2008-10-01
- Volume
- 51
- Issue
- 12
- Pages
- 2197-2204
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- PMC
- PMC2848756
- OpenAlex
- W2023547464
- Cited by
- 92
- References
- 31
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 6 · 2021: 9 · 2020: 12 · 2019: 8 · 2018: 2 · 2017: 1 · 2016: 6 · 2015: 6 · 2014: 3 · 2013: 4 · 2012: 3
- FWCI
- 3.15
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Scientific Electronic Library Online (São Paulo Research Foundation, Latin American and Caribbean Center on Health Sciences Information, Conselho Nacional de Desenvolvimento Científico e Tecnológico) (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Deutsche Forschungsgemeinschaft
- Conselho Nacional de Desenvolvimento Científico e Tecnológico
- National Institutes of Health (n01hc55021-47-0-1, n01hc55020-39-0-0, n01hc55016-37-0-0, n01hc055022-024, n01hc55019-35-0-1, n01hc55018-38-0-1, N01-HC55020, N01-HC-55021, N01-HC-55019, N01-HC-55022, N01-HC55016, N01-HC55018, N01-HC-55015, n01hc55015-48-0-1)
- National Heart, Lung, and Blood Institute (N01-HC55022, N01 HC055016, N01-HC-55018, N01 HC 55020, N01 HC 55019, N01 HC055020, N01 HC055018, N01-HC55016, N01 HC055022, N01 HC055019, N01‐HC‐55015, N01-HC55021, N01 HC055021, N01 HC055015)
- National Institute of Diabetes and Digestive and Kidney Diseases (K01DK076595)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- HbA1c, heart failure, diabetes mellitus, coronary artery disease, glycemic control, heart failure risk factors, heart failure hospitalization, heart failure mortality, tight glycemic control
- MeSH terms
- Female, Follow-Up Studies, Heart Failure, Glycated Hemoglobin, Humans, Male, Middle Aged, Risk Factors, Survival Rate, Diabetes Complications, Atherosclerosis
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