Diabetes, Glycemic Control, and New-Onset Heart Failure in Patients With Stable Coronary Artery Disease
Open accessAbstract
OBJECTIVE: Diabetes is a predictor of both coronary artery disease (CAD) and heart failure. It is unknown to what extent the association between diabetes and heart failure is influenced by other risk factors for heart failure. RESEARCH DESIGN AND METHODS: We evaluated the association of diabetes and A1C with incident heart failure in outpatients with stable CAD and no history of heart failure (average follow-up 4.1 years). RESULTS: Of 839 participants, 200 had diabetes (23.8%). Compared with patients who did not have diabetes, those with diabetes had an increased risk of heart failure (hazard ratio [HR] 2.17 [95% CI 1.37-3.44]). Adjustment for risk factors for CAD (age, sex, race, smoking, physical inactivity, obesity, blood pressure, and LDL cholesterol), interim myocardial infarction, and myocardial ischemia did not alter the strength of the association between diabetes and heart failure. After inclusion also of other risk factors for heart failure (left ventricular ejection fraction, diastolic dysfunction, and C-reactive protein) and medication use, diabetes remained an independent predictor of heart failure (HR 3.34 [95% CI 1.65-6.76]; P = 0.001). Each 1% increase in A1C concentration was associated with a 36% increased HR of heart failure hospitalization (HR 1.36 [95% CI 1.17-1.58]). CONCLUSIONS: In patients with stable CAD who are free from heart failure at baseline, diabetes and glycemic control are independent risk factors for new-onset heart failure. The mechanisms by which diabetes and hyperglycemia lead to heart failure deserve further study, as the association is independent of baseline functional assessment of ischemia, systolic and diastolic function, and interim myocardial infarction.
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The incidence of HF in T2DM patients compared to those without T2DM is even higher in patients with established CAD, in which each 1% increase in HbA1c level was associated with a 36% increased risk for HF hospitalization.
“The incidence of HF in T2DM patients compared to those without T2DM is even higher in patients with established CAD, in which each 1% increase in HbA 1c level was associated with a 36% increased risk for HF hospitalization.66,67”
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 [67]
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- Authors
- van Melle, J. P., Bot, M., de Jonge, P., de Boer, R. A., van Veldhuisen, D. J., & Whooley, M. A.
- Affiliations
- Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands;
- Tilburg University (NL)
- Department of Medical Psychology, Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands;
- San Francisco VA Medical Center (US)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2010-09-01
- Volume
- 33
- Issue
- 9
- Pages
- 2084-2089
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC2928369
- OpenAlex
- W2046496330
- Cited by
- 159
- References
- 31
- Citations by year
- 2026: 4 · 2025: 12 · 2024: 16 · 2023: 20 · 2022: 13 · 2021: 22 · 2020: 16 · 2019: 6 · 2018: 10 · 2017: 11 · 2016: 3 · 2015: 4 · 2014: 3 · 2013: 4 · 2012: 8
- FWCI
- 4.17
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- Research portal (Tilburg University) (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (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 › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- diabetes mellitus, heart failure, stable coronary artery disease, glycemic control, HbA1c, hyperglycemia, heart failure risk factors, heart failure hospitalization, diastolic dysfunction, left ventricular ejection fraction, C-reactive protein, myocardial infarction
- MeSH terms
- Aged, Coronary Artery Disease, Diabetes Mellitus, Female, Heart Failure, Hospitalization, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Proportional Hazards Models, Diabetes Complications, Kaplan-Meier Estimate
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