STOCKHOLM (EGMN) – Suboptimal glycemic control is an independent risk factor for a linear increase in the rate of new-onset heart failure in patients with type 2 diabetes, a large Scottish prospective case-control study indicates.
Moreover, in type 2 diabetes patients who already have established heart failure, poor glycemic control is independently associated with increased mortality, Dr. Chim Choy Lang reported at the annual congress of the European Society of Cardiology.
These were the key findings in a new analysis from the Tayside Study, which Dr. Lang directs. The ongoing project provides an unusual opportunity to prospectively follow an entire Scottish community, population 400,000.
“We can track patients with diabetes mellitus, looking at mean [hemoglobin A1c] over time, and see who develops heart failure. Our bioinformatics platform allows us to track all sorts of biologic variables, prescribing information, and outcomes data,” he explained in an interview.
The analysis was performed because controversy has arisen surrounding the relationship between glycemic control in type 2 diabetes and heart failure. Some recent evidence suggests tight metabolic control is actually associated with worse survival in the setting of heart failure.
“It should be noted that most of these studies were based on a single measure of HbA1c. I think there’s always cause for concern about that kind of analysis,” observed Dr. Lang, a cardiologist at the University of Dundee.
He reported on more than 9,000 Tayside residents with type 2 diabetes, 841 of whom developed heart failure during 1991-2008. Each diabetic heart failure patient was matched by age, gender, and date of diagnosis of diabetes to five controls.
In a multivariate logistic regression analysis, mean HbA1c during the study period was associated in linear fashion with the risk of later developing heart failure. Each 1% increase in HbA1c was independently linked to a 19% increase in incident heart failure after the researchers controlled for patients’ mean arterial pressure and use of thiazolidinediones.
Further, in type 2 diabetic patients with diagnosed heart failure, each 1% increase in mean HbA1c was independently associated with an adjusted 16% increase in all-cause mortality, according to Dr. Lang.
“I think our findings are an argument for tight glycemic control in diabetic patients with heart failure. The question is how to achieve that. I’m a big believer in metformin for that purpose,” the cardiologist said.
Asked if the increased risk of mortality documented in diabetic patients with poor glycemic control and heart failure is a marker for poor adherence to standard heart failure medications or is due to the adverse effects of high blood glucose, Dr. Lang said that’s a key unsettled question.
“We have the ability to look at treatment adherence in this cohort and are doing so at the moment,” he added.
He declared having no financial conflicts in connection with the study, which was conducted free of industry involvement.
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斯德哥尔摩(EGMN)——根据一项苏格兰大型前瞻性病例对照研究结果，对于2型糖尿病患者，血糖控制不理想是新发心力衰竭发生率直线增加的独立危险因素，是已患心力衰竭者病死率增加的独立危险因素。
邓迪大学的心脏病学家Chim Choy Lang博士及其同事利用苏格兰生物信息平台，对人群各种生物学变量、治疗情况及患者结局进行追踪，并对数据进行分析。研究者追踪了1991~2008年间超过9,000名患有2型糖尿病的泰塞德地区居民，其中841名发展为心力衰竭。每位糖尿病心力衰竭患者在年龄、性别和诊断糖尿病日期方面均与其对照相匹配。
经多元逻辑回归分析显示，患者平均糖化血红蛋白(HbA1c)水平与心力衰竭的发生率间呈线性增加关系。当研究者以平均动脉压和使用噻唑烷二酮作为配对控制条件时，平均HbA1c水平每增加1%，心力衰竭发生率增加19%。而在已患心力衰竭的2型糖尿病患者中，平均HbA1c水平每增加1%，校正后的全因病死率则增加16%。
研究者称，血糖控制不理想并患有心力衰竭的2型糖尿病患者病死率增加是标准的心力衰竭治疗疗效不佳的结果还是高血糖造成的恶果，对此尚待进一步研究确定。
Lang博士无相关的经济利益冲突披露。
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