Glycemic status and incident heart failure in elderly without history of diabetes mellitus: the health, aging, and body composition study.

Abstract

BACKGROUND:

It is unclear whether measures of glycemic status beyond fasting glucose (FG) levels improve incident heart failure (HF) prediction in patients without history of diabetes mellitus (DM).

METHODS AND RESULTS:

The association of measures of glycemic status at baseline (including FG, oral glucose tolerance testing [OGTT], fasting insulin, hemoglobin A(1c) [HbA(1c)] levels, and homeostasis model assessment of insulin resistance [HOMA-IR] and insulin secretion [HOMA-B]) with incident HF, defined as hospitalization for new-onset HF, was evaluated in 2386 elderly participants without history of DM enrolled in the Health, Aging, and Body Composition Study (median age, 73 years; 47.6% men; 62.5% white, 37.5% black) using Cox models. After a median follow-up of 7.2 years, 185 (7.8%) participants developed HF. Incident HF rate was 10.7 cases per 1000 person-years with FG <100mg/dL, 13.1 with FG 100-125 mg/dL, and 26.6 with FG >or=126 mg/dL (P=.002; P=.003 for trend). In adjusted models (for body mass index, age, history of coronary artery disease and smoking, left ventricular hypertrophy, systolic blood pressure and heart rate [HR], and creatinine and albumin levels), FG was the strongest predictor of incident HF (adjusted HR per 10mg/dL, 1.10; 95% CI, 1.02-1.18; P=.009); the addition of OGTT, fasting insulin, HbA(1c), HOMA-IR, or HOMA-B did not improve HF prediction. Results were similar across race and gender. When only HF with left ventricular ejection fraction (LVEF) <or=40% was considered (n=69), FG showed a strong association in adjusted models (HR per 10mg/dL, 1.15; 95% CI, 1.03-1.29; P=.01). In comparison, when only HF with LVEF >40%, was considered (n=71), the association was weaker (HR per 10mg/dL, 1.05; 95% CI; 0.94-1.18; P=.41).

CONCLUSIONS:

Fasting glucose is a strong predictor of HF risk in elderly without history of DM. Other glycemic measures provide no incremental prediction information.

• Authors: Andreas Kalogeropoulos, Vasiliki Georgiopoulou, Tamara B Harris, Stephen B Kritchevsky, Douglas C Bauer, Andrew L Smith, Elsa Strotmeyer, Anne B Newman, Peter W F Wilson, Bruce M Psaty, Javed Butler, Health ABC Study
• Journal: Journal of cardiac failure (J Card Fail) Vol. 15 Issue 7 Pg. 593-9 (Sep 2009) ISSN: 1532-8414 [Electronic] United States
• PMID: 19700136 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, N.I.H., Intramural)

Chemical References

• Blood Glucose

Topics

• Aged
• Aging (blood)
• Blood Glucose (metabolism)
• Body Composition (physiology)
• Cohort Studies
• Diabetes Mellitus (blood, epidemiology)
• Fasting (blood, physiology)
• Female
• Glycemic Index (physiology)
• Health Status
• Heart Failure (blood, complications, epidemiology)
• Humans
• Incidence
• Male