Letter Regarding Article, “Glucose Levels Predict Hospitalization for Congestive Heart Failure in Patients at High Cardiovascular Risk”

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HomeCirculationVol. 116, No. 10Letter Regarding Article, “Glucose Levels Predict Hospitalization for Congestive Heart Failure in Patients at High Cardiovascular Risk” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter Regarding Article, “Glucose Levels Predict Hospitalization for Congestive Heart Failure in Patients at High Cardiovascular Risk” George I. Varughese, MRCPI, MRCP (UK), Abd A. Tahrani, MD, MRCP and John H.B. Scarpello, MD, FRCP George I. VarugheseGeorge I. Varughese Department of Diabetes and Endocrinology, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom Search for more papers by this author , Abd A. TahraniAbd A. Tahrani Department of Diabetes and Endocrinology, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom Search for more papers by this author and John H.B. ScarpelloJohn H.B. Scarpello Department of Diabetes and Endocrinology, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom Search for more papers by this author Originally published4 Sep 2007https://doi.org/10.1161/CIRCULATIONAHA.107.703751Circulation. 2007;116:e339To the Editor:We applaud Held et al1 for their efforts to link the effects of glycemic control and hospitalizations for congestive heart failure. Their study demonstrates that after adjustment for age and sex, a 1-mmol/L higher fasting plasma glucose was associated with a 1.10-fold increased risk of congestive heart failure hospitalization (95% confidence interval 1.08 to 1.12, P<0.0001). The association persisted after adjustment for age, sex, smoking, previous myocardial infarction, hypertension, waist-to-hip ratio, creatinine, diabetes mellitus (DM), and use of aspirin, β-blockers, or statins (hazard ratio 1.05, 95% confidence interval 1.02 to 1.08, P<0.001).1 However, they have not evaluated the incidence of atrial fibrillation (AF) or atrial flutter in this specific group of congestive heart failure patients on the basis of fasting glucose levels. Fasting glucose levels are of significant relevance given the epidemiological and pathophysiological links between DM and AF, as well as the role of deranged glucose metabolism in the risk of new-onset AF.2–4Of note, previous studies that used stepwise models demonstrated that high fasting plasma glucose levels were associated with AF,2 and the Framingham study found that DM was a significant independent risk factor for AF, with an odds ratio (OR) of 1.4; interestingly, levels of blood glucose per se were more important predictors than the diagnosis of DM.3 In a recent large-scale study that took place over a 10-year period, AF occurred in 43 674 patients with DM (14.9%) versus 57 077 (10.3%) in the control group (P<0.0001).4 Atrial flutter occurred in 11 852 patients with DM (4%) versus 13 554 (2.5%) of the control group (P<0.0001). After multivariate analysis, DM remained independently associated with AF, with an OR of 2.13 (95% confidence interval 2.10 to 2.16, P<0.0001), and with atrial flutter (OR 2.20, 95% confidence interval 2.15 to 2.26, P<0.0001).4Hence, DM independently contributes to the risk of new-onset AF, and this effect is further exaggerated in patients with increasing body mass index.5 As an illustrative example, although the risk of obesity with AF is recognized, Dublin et al5 demonstrated that in a population-based case-control study that included 425 subjects with new-onset AF and 707 controls, the obesity-AF link was mediated in part by DM and only minimally by other cardiovascular risk factors. Therefore, it would be pertinent to analyze the results of the study by Held et al1 from this perspective of new-onset AF. The question remains whether fasting glucose levels directly caused congestive heart failure or whether it was an effect of AF, and this merits further evaluation.DisclosuresNone. References 1 Held C, Gerstein HC, Yusuf S, Zhao F, Hilbrich L, Anderson C, Sleight P, Teo K Glucose levels predict hospitalization for congestive heart failure in patients at high cardiovascular risk. Circulation. 2007; 115: 1371–1375.LinkGoogle Scholar2 Psaty BM, Manolio TA, Kuller LH, Kronmal RA, Cushman M, Fried LP, White R, Furberg CD, Rautaharju PM. Incidence of and risk factors for atrial fibrillation in older adults. Circulation. 1997; 96: 2455–2461.CrossrefMedlineGoogle Scholar3 Benjamin EJ, Levy D, Vaziri SM, D’Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort: the Framingham Heart Study. JAMA. 1994; 271: 840–844.CrossrefMedlineGoogle Scholar4 Movahed MR, Hashemzadeh M, Jamal MM. Diabetes mellitus is a strong, independent risk for atrial fibrillation and flutter in addition to other cardiovascular disease. Int J Cardiol. 2005; 105: 315–318.CrossrefMedlineGoogle Scholar5 Dublin S, French B, Glazer NL, Wiggins KL, Lumley T, Psaty BM, Smith NL, Heckbert SR. Risk of new-onset atrial fibrillation in relation to body mass index. Arch Intern Med. 2006; 166: 2322–2328.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails September 4, 2007Vol 116, Issue 10 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.107.703751PMID: 17768300 Originally publishedSeptember 4, 2007 PDF download Advertisement SubjectsArrhythmiasCongenital Heart DiseaseDiabetes, Type 1Diabetes, Type 2