Heart Failure Boosts Risk For New-Onset Diabetes

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 also showed a strong association between severity of heart failure symptoms and risk for new-onset diabetes: Patients with higher New York Association Class heart failure faced a greater risk for developing diabetes than did patients with less severe heart failure symptoms, Dr. Ankit Rathod said at the annual scientific sessions of the American Heart Association.

The hypothesized causal link between heart failure and diabetes is the neurohormonal, sympathetic activation that characterizes heart failure. This leads to norepinephrine release, which can trigger insulin resistance and hence increased susceptibility to developing diabetes, said Dr. Rathod, an internist at Wayne State University in Detroit. In addition, patients with more severe heart failure 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. 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), he said.

Dr. Rathod collected data 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 heart failure at enrollment, and 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; about half were women.

During an average follow-up of 24 years, 123 developed heart failure, and 468 developed new-onset diabetes. Forty-one of the 123 patients (33%) who developed heart failure 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 heart failure had a statistically significant 2.5-fold increased risk for later developing diabetes compared with the people who did not have heart failure.

Dr. Rathod and Dr. Yancy said they had no conflicts of interest.

Forty-one of the 123 patients (33%) who developed heart failure later developed diabetes.

Source DR. RATHOD

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 also showed a strong association between severity of heart failure symptoms and risk for new-onset diabetes: Patients with higher New York Association Class heart failure faced a greater risk for developing diabetes than did patients with less severe heart failure symptoms, Dr. Ankit Rathod said at the annual scientific sessions of the American Heart Association.

The hypothesized causal link between heart failure and diabetes is the neurohormonal, sympathetic activation that characterizes heart failure. This leads to norepinephrine release, which can trigger insulin resistance and hence increased susceptibility to developing diabetes, said Dr. Rathod, an internist at Wayne State University in Detroit. In addition, patients with more severe heart failure 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. 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), he said.

Dr. Rathod collected data 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 heart failure at enrollment, and 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; about half were women.

During an average follow-up of 24 years, 123 developed heart failure, and 468 developed new-onset diabetes. Forty-one of the 123 patients (33%) who developed heart failure 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 heart failure had a statistically significant 2.5-fold increased risk for later developing diabetes compared with the people who did not have heart failure.

Dr. Rathod and Dr. Yancy said they had no conflicts of interest.

Forty-one of the 123 patients (33%) who developed heart failure later developed diabetes.

Source DR. RATHOD

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 also showed a strong association between severity of heart failure symptoms and risk for new-onset diabetes: Patients with higher New York Association Class heart failure faced a greater risk for developing diabetes than did patients with less severe heart failure symptoms, Dr. Ankit Rathod said at the annual scientific sessions of the American Heart Association.

The hypothesized causal link between heart failure and diabetes is the neurohormonal, sympathetic activation that characterizes heart failure. This leads to norepinephrine release, which can trigger insulin resistance and hence increased susceptibility to developing diabetes, said Dr. Rathod, an internist at Wayne State University in Detroit. In addition, patients with more severe heart failure 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. 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), he said.

Dr. Rathod collected data 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 heart failure at enrollment, and 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; about half were women.

During an average follow-up of 24 years, 123 developed heart failure, and 468 developed new-onset diabetes. Forty-one of the 123 patients (33%) who developed heart failure 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 heart failure had a statistically significant 2.5-fold increased risk for later developing diabetes compared with the people who did not have heart failure.

Dr. Rathod and Dr. Yancy said they had no conflicts of interest.

Forty-one of the 123 patients (33%) who developed heart failure later developed diabetes.

Source DR. RATHOD