Eplerenone and new-onset diabetes in patients with mild heart failure: results from the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF)
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AIMS: No studies have examined the effect of mineralocorticoid receptor antagonist therapy on new-onset diabetes. In addition, though the combination of diabetes and chronic heart failure (CHF) carries a poor prognosis, few studies have examined predictors of new-onset diabetes in those with CHF. METHODS AND RESULTS: In patients with symptomatically mild CHF who participated in the placebo-controlled Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure, we examined the effect of the aldosterone antagonist, eplerenone, on physician-diagnosed diabetes using univariate Cox proportional hazard analysis. To identify predictors of new-onset diabetes (measures of glycaemia were not available), data from trial arms were combined and multivariate Cox proportional hazard analyses and receiver operating characteristic curve analyses were conducted. At baseline, the mean age of 1846 initially non-diabetic patients was 69 years and mean left ventricular ejection fraction was 26%. Over 21 months, 69 (3.7%) developed diabetes (33 on eplerenone, 36 on placebo). Eplerenone had no effect on new-onset diabetes [hazard ratio (HR) 0.94, 95% confidence interval (CI) 0.59-1.52] and no effect on the composite of new-onset diabetes or mortality (HR 0.80, 95% CI 0.64-1.01). Independent predictors of new-onset diabetes included digoxin therapy, higher serum alanine aminotransferase, longer duration of heart failure, current or previous smoker, higher waist circumference, lower age, and higher systolic blood pressure with a combined c-statistic of 0.74. CONCLUSIONS: Eplerenone had no effect on new-onset diabetes in patients with CHF, but further large-scale studies are required to address this question comprehensively. Commonly recorded parameters provided useful information for predicting new-onset diabetes.
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In the EMPHASIS-HF trial including HFrEF patients, the incidence of T2DM was 3.7% over a median follow-up of 21 months.
“In the EMPHASIS-HF trial including HFrEF patients, the incidence of T2DM was 3.7% over a median follow-up of 21 months.57”
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 [57]
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- Authors
- Preiss, D., van Veldhuisen, D. J., Sattar, N., Krum, H., Swedberg, K., Shi, H., Vincent, J., Pocock, S. J., Pitt, B., Zannad, F., & McMurray, J. J. V.
- Affiliations
- British Heart Foundation (GB)
- Department of Cardiology, Thorax Center, University Medical Center , Groningen ,
- Monash University (AU)
- University of Gothenburg (SE)
- Pfizer (United States) (US)
- University of London (GB)
- University of Michigan (US)
- Inserm (FR)
- Corresponding author
- McMurray, John J.V.
- ORCID
- Venue
- European Journal of Heart Failure
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-08-01
- Volume
- 14
- Issue
- 8
- Pages
- 909-915
- ISSN
- 1388-9842 (ISSN-L)
- 1879-0844
- OpenAlex
- W2018496819
- Cited by
- 79
- References
- 24
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 5 · 2023: 4 · 2022: 6 · 2021: 12 · 2020: 7 · 2019: 7 · 2018: 4 · 2017: 2 · 2016: 4 · 2015: 3 · 2014: 6 · 2013: 8
- FWCI
- 3.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Research Bank (Australian Catholic University) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- eplerenone, new-onset diabetes, chronic heart failure, mineralocorticoid receptor antagonists, diabetes risk factors, digoxin, alanine aminotransferase, smoking, waist circumference, systolic blood pressure, mortality
- MeSH terms
- Eplerenone, Aged, Mineralocorticoid Receptor Antagonists, Diabetes Mellitus, Female, Heart Failure, Hospitalization, Humans, Male, Prognosis, Risk Factors, Severity of Illness Index, Spironolactone, Proportional Hazards Models
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