Abstract
PurposeThe prevalence and consequences of prediabetic dysglycemia and undiagnosed diabetes is unknown in patients with heart failure (HF) and preserved ejection fraction (HFpEF) and has not been compared to heart failure and reduced ejection fraction (HFrEF).MethodsWe examined the prevalence and outcomes associated with normoglycemia, prediabetic dysglycemia and diabetes (diagnosed and undiagnosed) among individuals with a baseline glycated hemoglobin (hemoglobin A1c, HbA1c) measurement stratified by HFrEF or HFpEF in the Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity programme (CHARM). We studied the primary outcome of HF hospitalization or cardiovascular (CV) death, and all-cause death, and estimated hazard ratios (HR) by use of multivariable Cox regression models.ResultsHbA1c was measured at baseline in CHARM patients enrolled in the USA and Canada and was available in 1072/3023 (35%) of patients with HFpEF and 1578/4576 (34%) patients with HFrEF. 18 and 16% had normoglycemia (HbA1c < 6.0), 20 and 22% had prediabetes (HbA1c 6.0–6.4), respectively. Finally among patients with HFpEF 22% had undiagnosed diabetes (HbA1c > 6.4), and 40% had known diabetes (any HbA1c), with corresponding prevalence among HFrEF patients being 26 and 35%. The rates of both clinical outcomes of interest were higher in patients with undiagnosed diabetes and prediabetes, compared to normoglycemic patients, irrespective of HF subtype, and in general higher among HFrEF patients. For the primary composite outcome among HFpEF patients, the HRs were 1.02 (95% CI 0.63–1.65) for prediabetes, HR 1.18 (0.75–1.86) for undiagnosed diabetes and 2.75 (1.83–4.11) for known diabetes, respectively, p value for trend across groups < 0.001. Dysglycemia was also associated with worse outcomes in HFrEF.ConclusionsThese findings confirm the remarkably high prevalence of dysglycemia in heart failure irrespective of ejection fraction phenotype, and demonstrate that dysglycemia is associated with a higher risk of adverse clinical outcomes, even before the diagnosis of diabetes and institution of glucose lowering therapy in patients with HFpEF as well as HFrEF.
Highlights
People with diabetes have a higher risk of developing incident heart failure (HF) than those without diabetes [1,2,3] and among patients with HF, those with diabetes have worse outcomes than patients without diabetes [4,5,6]
HbA1c was measured at baseline in CHARM patients enrolled in the USA and Canada and was available in 1072/3023 (35%) of patients with HF with preserved ejection fraction (HFpEF) and 1578/4576 (34%) patients with HF with reduced ejection fraction (HFrEF). 18 and 16% had normoglycemia (HbA1c < 6.0), 20 and 22% had prediabetes (HbA1c 6.0–6.4), respectively
These findings confirm the remarkably high prevalence of dysglycemia in heart failure irrespective of ejection fraction phenotype, and demonstrate that dysglycemia is associated with a higher risk of adverse clinical outcomes, even before the diagnosis of diabetes and institution of glucose lowering therapy in patients with HFpEF as well as HFrEF
Summary
People with diabetes have a higher risk of developing incident heart failure (HF) than those without diabetes [1,2,3] and among patients with HF, those with diabetes have worse outcomes than patients without diabetes [4,5,6]. Cardiovasc Drugs Ther (2017) 31:545–549 diabetes is high among patients with HF, affecting between 25 and 50% of individuals depending on which study is examined. Both undiagnosed diabetes and prediabetic dysglycemia were found to be common in patients with HF with reduced ejection fraction (HFrEF) and each was associated with worse outcomes, compared with normoglycemia, the risk was not as high as in patients with diagnosed diabetes [7]. The aim of our study was to determine the prevalence and prognostic significance of undiagnosed diabetes and prediabetic dysglycemia in the other major HF phenotype, HF with preserved ejection fraction (HFpEF), and compare the prevalence and outcomes with those in contemporaneously recruited patients with HFrEF. We used data from the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme, which included patients with HFrEF and HFpEF [6, 8]
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