Abstract
BackgroundIn population studies of heart failure (HF), diabetes has been shown to be an independent risk factor. However, the evidence evaluating diabetes mellitus (DM) as an independent risk factor in incident HF in patients with ischemic heart disease (IHD) is scarce. Our study aimed to assess the incidence of HF in diabetic IHD patients compared to non-diabetic IHD patients in Ethiopia.MethodsA retrospective cohort study was conducted among 306 patients with IHD followed-up at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia. The IHD patients who did not have HF at baseline were followed for 24 months beginning from November 30, 2015. We assessed the incidence of HF in patients with diabetic IHD versus the non-diabetic IHD. Cox proportional hazards models were used to assess the association between diabetic IHD and HF after controlling for important covariates. Hypertension was examined as a possible effect modifier as well.ResultsThe mean age was 56.8 years, 69% were male, and 31% were diabetic. During the 24 months follow-up period, 196 (64.1%) had incident HF. On multivariate Cox regression, DM was significantly associated with incident HF [Hazard Ratio = 2.04, 95% confidence interval (CI): 1.32–3.14, p = 0.001]. Furthermore, when the patients were stratified by hypertension (HTN), DM was associated with worse prognosis, the strongest association being in those with co-existing DM and HTN [HR = 2.57,95% CI =1.66–3.98, p < 0.0001] followed by the presence of DM without HTN [HR 2.27, 95% CI = 1.38–3.71, p = 0.001] (compared to those with neither).ConclusionDM is the strongest predictor of incident HF, compared to other traditional risk factors, in Ethiopian patients with IHD. Those with both DM and HTN are at the highest risk.
Highlights
In population studies of heart failure (HF), diabetes has been shown to be an independent risk factor
Study design and clinical setting This is a retrospective cohort study done at Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia to assess the incremental effect of diabetes mellitus (DM) on incident HF in patients with ischemic heart disease (IHD).TASH is an institution where specialized clinical services are rendered to the whole nation
The proportion of admission to hospital, smoking, HTN, dyslipidemia, functional class III-IV HF and nephropathy were higher in the diabetic IHD patients
Summary
In population studies of heart failure (HF), diabetes has been shown to be an independent risk factor. The evidence evaluating diabetes mellitus (DM) as an independent risk factor in incident HF in patients with ischemic heart disease (IHD) is scarce. With a population of close to 100 million and the second in population from Africa, is experiencing swift changes in the health and disease of its population like many of the rapidly developing countries in Africa. These changes are accompanied or driven by. Most cardiovascular diseases (CVDs) can be prevented by addressing these risk factors [11]
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