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Prevalence and clinical consequences of dysglycaemia in nondiabetic patients with chronic heart failure
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Mohan, Mohapradeep (2017) Prevalence and clinical consequences of dysglycaemia in nondiabetic patients with chronic heart failure. In: European Society of Cardiology Acute Heart Failure Congress, Paris, France, 29 Apr – 2 May 2017. Published in: European Journal of Heart Failure, 19 (S1). doi:10.1002/ejhf.833 ISSN 1388-9842.
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Official URL: http://dx.doi.org/10.1002/ejhf.833
Abstract
Background & Aim:
Chronic heart failure (CHF) and diabetes mellitus (DM) frequently co-exist and its clinical consequences has been undoubtedly established in the past. CHF is a state of insulin resistance and it is believed that glucose abnormalities are very common in CHF patients even in the absence of DM, exposing them to a higher risk of developing DM. This study sought to establish the prevalence and risk related to prediabetes among nondiabetic CHF patients.
Methods:
1805 CHF patients (age 74±11, 34% females, 64% IHD aetiology; 57% in NYHA III/IV; BMI 29 ± 6 kg/m², 42% all-cause deaths) were evaluated prospectively from the BIOSTAT-CHF Scotland study. Pre-diabetes was defined using the new glycosylated haemoglobin A1C (HbA1c) criteria (6.0-6.4%) proposed by the International Diabetes Expert Committee (IEC). Patients with a diagnosis of DM (33%) or undiagnosed DM (5%, baseline HbA1c= 6.5 %) and patients with no baseline HbA1c (14%) were excluded from the study. Cox regression models were used to assess all-cause mortality rates, adjusting for significant covariates.
Results: After exclusion, prevalence of prediabetes was 33% by IEC criteria in our cohort of CHF patients (n=876). During a median follow-up period of 4.7 years (IQR 4.5, 4.9), there were 39% all-cause deaths. A Kaplan- Meier analysis showed that mortality rates were significantly higher (46% vs 35%; p=0.006) in prediabetic CHF patients as compared to normoglycemic (NG) CHF patients. Prediabetic CHF patients had more symptomatic CHF (% of patients in NYHA III-IV, 62% vs 52%, p=0.009) as compared with NG-CHF patients. A Cox regression model, adjusted for significant covariates showed that prediabetic CHF patients were at higher risk of deaths (HR 1.3 [1.02 – 1.7]; p<0.05) compared to NG-CHF patients.
Conclusion: In patients with CHF, high-normal baseline HbA1c levels in the absence of DM have a significantly increased risk of all-cause mortality. Targeted therapeutic strategies to prevent or delay the onset of DM is urgently needed in these CHF patients identified to have pre-diabetes.
Item Type: | Conference Item (Speech) | ||||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Journal or Publication Title: | European Journal of Heart Failure | ||||||
Publisher: | John Wiley & Sons Ltd. | ||||||
ISSN: | 1388-9842 | ||||||
Official Date: | May 2017 | ||||||
Dates: |
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Volume: | 19 | ||||||
Number: | S1 | ||||||
DOI: | 10.1002/ejhf.833 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||
Conference Paper Type: | Speech | ||||||
Title of Event: | European Society of Cardiology Acute Heart Failure Congress | ||||||
Type of Event: | Conference | ||||||
Location of Event: | Paris, France | ||||||
Date(s) of Event: | 29 Apr – 2 May 2017 |
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