ORLANDO — Patients with heart failure had a greater than twofold increased risk of developing diabetes compared with people without heart failure in a review of more than 4,600 individuals in the Framingham Offspring Study.
The analysis showed a strong association between severity of heart failure (HF) symptoms and risk for new-onset diabetes: Patients with higher New York Association Class HF faced a greater risk for developing diabetes than did patients with less severe HF symptoms, Dr. Ankit Rathod said at the annual scientific sessions of the American Heart Association.
The implications are that patients with HF should undergo more intensive surveillance for development of insulin resistance and diabetes. The findings also present a new reason for optimized HF treatment to minimize symptom severity because this may cut the patient's risk for developing diabetes, Dr. Rathod said in an interview.
The hypothesized causal link between HF and diabetes is the neurohormonal, sympathetic activation that characterizes HF. This leads to norepinephrine release, which can trigger insulin resistance and hence increased susceptibility to developing diabetes, said Dr. Rathod, an internal medicine physician at Wayne State University, Detroit. In addition, patients with more severe HF symptoms have reduced activity, which might exacerbate insulin resistance and the risk for developing diabetes.
“I believe the connections between insulin resistance and neurohormonal activation are a real phenomenon,” said Dr. Clyde W. Yancy, medical director of the Baylor Heart and Vascular Institute at Baylor University Medical Center in Dallas. He cited study results showing that treatment with drugs that block neurohormonal activation also cut development of diabetes, such as with ramipril in the HOPE study (N. Engl. J. Med 2000;342:145-53) and treatment with carvedilol in the CAPRICORN study (Lancet 2001;357:1385-90).
Dr. Rathod's study used data collected from the more than 4,900 people enrolled into the Framingham Offspring Study in 1971. He and his associates excluded people with a history of diabetes or HF at the time of enrollment, as well as those who had missing data on their subsequent rate of new-onset diabetes. The 4,614 people included in the study had an average age of 35, and about half were women.
During an average follow-up of 24 years, 123 developed HF, and 468 developed new-onset diabetes. Forty-one of the 123 patients (33%) who developed HF later developed diabetes, compared with 427 new cases of diabetes among the other 4,491 people (10%).
In a multivariate analysis that adjusted for baseline demographic and clinical differences, including drug treatments and baseline blood glucose levels, patients who first developed HF had a statistically significant 2.5-fold increased risk for later developing diabetes compared with those who did not have HF.
The link between HF and diabetes should be examined in other databases, Dr. Rathod said. He and Dr. Yancy disclosed having no financial conflicts of interest.
Patients who first developed HF had a statistically significant 2.5-fold increased risk for future diabetes.
Source DR. RATHOD