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CLINICAL RESEARCH: HEART FAILURE

The association of fasting glucose levels with congestive heart failure in diabetic adults 65 years

The Cardiovascular Health Study

Joshua I. Barzilay, MD^*,*, Richard A. Kronmal, PhD, John S. Gottdiener, MD, Nicholas L. Smith, PhD, MPH, Gregory L. Burke, MD, MS^||, Russell Tracy, PhD^¶, Peter J. Savage, MD^# and Michelle Carlson, PhD^**

^* Kaiser Permanente of Georgia and the Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia, USA
Department of Biostatistics, University of Washington, Seattle, Washington, USA
Department of Epidemiology, University of Washington, Seattle, Washington, USA
Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
^|| Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
^¶ Department of Pathology, University of Vermont College of Medicine, Colchester, Vermont, USA
^# Division of Epidemiology and Clinical Applications, National Heart, Lung, Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
^** Center on Aging and Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA

Manuscript received July 29, 2003; revised manuscript received October 15, 2003, accepted October 20, 2003.

^* Reprint requests and correspondence: Dr. Joshua I. Barzilay, Kaiser Permanente of Georgia, 200 Crescent Center Parkway, Tucker, Georgia 30084.
joshua.barzilay{at}kp.org

OBJECTIVES: The purpose of this study was to determine if fasting glucose levels are an independent risk factor for congestive heart failure (CHF) in elderly individuals with diabetes mellitus (DM) with or without coronary heart disease (CHD).

BACKGROUND: Diabetes mellitus and CHF frequently coexist in the elderly. It is not clear whether fasting glucose levels in the setting of DM are a risk factor for incident CHF in the elderly.

METHODS: A cohort of 829 diabetic participants, age 65 years, without prevalent CHF, was followed for five to eight years. The Cox proportional hazards modeling was used to determine the risk of CHF by fasting glucose levels. The cohort was categorized by the presence or absence of prevalent CHD.

RESULTS: For a 1 standard deviation (60.6 mg/dl) increase in fasting glucose, the adjusted hazard ratios for incident CHF among participants without CHD at baseline, with or without an incident myocardial infarction (MI) or CHD event on follow-up, was 1.41 (95% confidence interval 1.24 to 1.61; p < 0.0001). Among those with prevalent CHD at baseline, with or without another incident MI or CHD event on follow-up, the corresponding adjusted hazard ratio was 1.27 (95% confidence interval 1.02 to 1.58; p < 0.05).

CONCLUSIONS: Among older adults with DM, elevated fasting glucose levels are a risk factor for incident CHF. The relationship of fasting glucose to CHF differs somewhat by the presence or absence of prevalent CHD.

Abbreviations and Acronyms   CHD = coronary heart disease   CHF = congestive heart failure   CHS = Cardiovascular Health Study   DM = diabetes mellitus   LV = left ventricle/ventricular   MI = myocardial infarction

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