Diabetes increasingly prevalent in heart failure

The prevalence of diabetes is increasing among older persons with heart failure, and diabetes is a significant independent risk factor for death in these individuals.

The findings, appearing in The American Journal of Medicine, underscore the importance of tight control of diabetes, researchers at the Mayo Clinic in Rochester, Minnesota, assert.

Dr. Aaron M. From and associates analyzed a random group of 665 people living independently in Olmstead County who were first diagnosed with heart failure between 1979 and 1999. The average age of these individuals was 77 years and 20 percent had a pre-existing diagnosis of diabetes.

Those with diabetes tended to be younger and weighed more than heart failure patients without diabetes. They also had lower left ventricular ejection fractions - a measure of the heart's blood-pumping power.

The prevalence of diabetes increased 3.8 percent per year. The odds of having diabetes for those first diagnosed with heart failure in 1999 was nearly four times higher than those diagnosed 20 years earlier in 1979.

Five-year survival was 46 percent for those with heart failure alone, but only 37 percent for those with heart failure and diabetes.

Counterintuitively, subjects with diabetes and no coronary artery disease had a significantly higher risk of death than those with diabetes and coronary disease, compared to patients with neither diabetes nor heart disease. The authors suggest this finding may reflect under-recognition of heart disease in diabetic subjects.

The increasing prevalence of diabetes and its associated increase in risk of death "delineates a substantial opportunity to improve the outcome of heart failure by preventing diabetes and, once present, by aggressively evaluating and treating it," From and colleagues conclude.

SOURCE: American Journal of Medicine July, 2006.