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Diabetes Mellitus Is an Independent Predictor for the Development of Heart Failure

A Population Study

      Abstract

      Objectives

      To delineate the impact of diabetes mellitus (DM) on the development of cardiovascular diseases in a community population.

      Patients & Methods

      Cross-sectional survey of residents randomly selected through the Rochester Epidemiology Project, 45 years or older, of Olmsted County as of June 1, 1997, through September 30, 2000. Responders (2042) underwent assessment of systolic and diastolic function using echocardiography. The current analyses included all participants with DM and were compared with a group of participants without DM matched 1:2 for age, sex, hypertension, and coronary artery disease. Baseline characteristics and laboratory and echocardiography findings between groups were compared along with rates of mortality due to various cardiovascular conditions.

      Results

      We identified 116 participants with DM and 232 matched participants without DM. Those with DM had a higher body mass index and plasma insulin and serum glucose levels. Although left ventricular ejection fractions were similar, E/e' ratio (9.7 vs 8.5; P=.001) was higher in DM vs non-DM. During a follow-up of 10.8 (interquartile range, 7.8-11.7) years, participants with DM had a higher incidence of heart failure (HF); hazard ratio, 2.1; 95% confidence limits, 1.2-3.6; P=.01) and 10-year Kaplan-Meier rate of 21% (22 of 116) vs 12% (24 of 232) compared with those without DM. We also examined the subgroup of participants without diastolic dysfunction. In this subgroup, those with DM had an increased risk for HF; hazard ratio, 2.5; 95% confidence limits, 1.0-6.3; P=.04).

      Conclusion

      In this cohort, participants with DM have an increased incidence of HF over a 10-year follow-up period even in the absence of underlying diastolic dysfunction. These findings suggest that DM is an independent risk factor for the development of HF and supports the concept of DM cardiomyopathy.

      Abbreviations and Acronyms:

      BMI (body mass index), CAD (coronary artery disease), DCM (diabetic cardiomyopathy), DM (diabetes mellitus), E (passive transmitral left ventricular inflow velocity), e′ (tissue Doppler imaging velocity of the medial mitral annulus during passive filling), EF (ejection fraction), HF (heart failure), HR (hazard ratio), HTN (hypertension), LA (left atrial), LV (left ventricular), MI (myocardial infarction), NT-proBNP (N-terminal prohormone of brain natriuretic peptide), REP (Rochester Epidemiology Project), ROS (reactive oxygen species)
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