he European Association for the Study of Diabetes
Heart failure and cardiovascular complications in diabetes
MedWire News – European Association for the Study of Diabetes (Lisbon, Portugal), September 13th, 2011: Hospitalizations for heart failure (HF) and other cardiovascular diseases (CVDs) among patients with diabetes were the subject of an open presentation session held on the first day of the 47th European Association for the Study of Diabetes (EASD) conference in Lisbon, Portugal.
The relationship between glycemic control and HF admissions to hospital among patients with diabetes, as well as changes in general trends of CVD admissions to hospital among patients with and without diabetes in England over the last decade, were discussed.
Poor glycemic control increases HF admissions
Marcus Lind, Diabetic Center, Sahlgrenska University of Gothenburg,
and Uddevalla, Sweden
The prevalence of HF is increasing in many countries and is known to affect 2.5-times more diabetic than non-diabetic patients [1].
Intensive glycemic control has been shown to have no preventive effect against HF in patients with diabetes [2], but observational studies have had contrasting results.
To further investigate the effects of glycemic control on outcomes in diabetic patients with HF, Lind and colleagues analyzed data from the Swedish National Diabetes Register.
In total, 83,021 patients with Type 2 diabetes who were enrolled into the register between 1998 and 2003 and aged 65.8 years on average, were included. They had a mean body mass index (BMI) of 28.9 kg/m2 and a mean glycated hemoglobin (HbA1c) of 7.4%.
The patients were all initially free of HF, although 16.2% had experienced a prior myocardial infarction (MI), and were followed-up until 2009 for hospitalization for primary or secondary HF.
Over a median follow-up time of 7.2 years, 10,969 (13.2%) of the patients with Type 2 diabetes in the registry were hospitalized for HF.
Notably, following adjustment for various factors including age, gender, diabetes duration, BMI, and blood pressure, patients with an HbA1c level above 10% had a 2.01-fold increased risk for HF hospitalization compared with patients who had an HbA1c below 6.0%.
Each percentage unit increase in HbA1c increased a patient’s risk for HF admission by a significant 16%.
Male gender, older age, and longer diabetes duration also increased the risk for HF hospitalization.
Lind conceded that it “is not possible to conclude whether good glycemic control prevents or reverses HF due to the non-randomized nature of the study.”
However, he added that the results suggest that poor glycemic control is a significant risk factor for HF in patients with Type 2 diabetes.
Admissions for CVD improved, but still room for change
Eszter Vamos, Imperial College London, UK
CVD has decreased significantly in the general population over the past 50 years, particularly in developed countries like England.
Some studies have suggested that rates of CVD have decreased at a similar rate in patients with diabetes [3]; however, other studies have had conflicting results [4].
To investigate changes in trends in hospital admissions for major CVD events in England during 2004–2009, Vamos and colleagues identified all patients aged 16 years or older who were admitted to National Health Service hospitals with angina, acute MI, or stroke, or for percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG) during this time using hospital episode statistics collected by the Department of Health in the UK.
Quality Management and Analysis System data on patients aged 17 years or above was used to calculate diabetes and non-diabetes specific rates for each year.
Although patients with diabetes had a CVD event rate between 3.5- and 5.0-fold higher than that of the non-diabetic people, Vamos explained that similar proportional changes in CVD event rates occurred between patients with and without diabetes between 2004 and 2009.
Rates of admission for angina, acute MI, and CABG in patients with diabetes decreased significantly over the study period by 5%, 5%and 3% per year, respectively, with similar rates seen for non-diabetics.
However, the incidence of stroke did not change significantly and the rate of PCI increased by 2% and 3% in people with and without diabetes, respectively. Of note, the median length of hospital stay decreased significantly in both diabetics and non-diabetics over the study period.
In-hospital mortality for acute MI and stroke also went down significantly during the same time period in both people with and without diabetes, but stayed the same for patients with CABG, and increased for patients with PCI.
“These results might reflect changes in historical patterns of care in England,” said Vamos. “People with diabetes now get more aggressive management for their care than previously.”
“These findings emphasize the ongoing need for aggressive risk-reduction,” she concluded.
References
1. Nichols GA, Gullion CM, Koro CE, Ephross SA, Brown JB. The incidence of congestive heart failure in Type 2 diabetes: an update. Diabetes Care 2004;27: 1879–1884.
2. Turnbull FM, Abraira C, Anderson RJ, et al. Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia 2009;52:2288–2298.
3. Booth GL, Kapral MK, Fung K, Tu JV. Recent trends in cardiovascular complications among men and women with and without diabetes. Diabetes Care 2006;29:32–37.
4. Thomas RJ, Palumbo PJ, Melton LJ 3rd, et al. Trends in the mortality burden associated with diabetes mellitus: a population-based study in Rochester, Minn, 1970-1994. Arch Intern Med 2003 24;163:445–451.
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Publicerad: |2011-09-21|