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Epidemiology of Diabetes and Heart Failure

Epidemiology of Diabetes and Heart Failure. David McFadden M.D. Mayo Clinic. Heart failure (HF) affects ＞ 5 million persons and is responsible for ＞ 250,000 deaths in the United States annually.

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Epidemiology of Diabetes and Heart Failure

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  1. Epidemiology of Diabetes and Heart Failure David McFadden M.D. Mayo Clinic

  2. Heart failure (HF) affects ＞5 million persons and is responsible for ＞250,000 deaths in the United States annually. • HF hospitalization rates in the United States increased by nearly 33% from 1990–2004, in contrast to a contemporaneous decrease in hospitalization rates for myocardial infarction of 8%.

  3. Diabetes mellitus and HF commonly coexist. With the increasing prevalence of obesity and diabetes in the United States, it can be expected that the population with diabetes who have HF will also increase.

  4. Framingham cohort • an association between diabetes and the risk for incident HF independent of differences in coexisting CAD or hypertension. • the proportion of HF cases in a population accounted for by diabetes alone was 12% in women and 6% in men.

  5. Cardiovascular Health Study

  6. Diabetes conferred a significantly higher independent risk for incident HF in 5,888 older patients followed for an average of 5.5 years (relative risk [RR], 1.78). • The proportion of incident HF in the population due to diabetes was greater than that due to renal dysfunction, electrocardiographic left ventricular hypertrophy, or left ventricular systolic dysfunction .

  7. Kaiser Permanente database • It corroborated the Framingham and CHS results • Strikingly, the prevalence of HF in patients with diabetes in this population exceeded 1 in 9.

  8. In clinical trial populations • Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), which enrolled subjects aged ≥ 55 years with hypertension and ≥1 other cardiovascular risk factor. • Davis and colleagues found that patients with diabetes had a nearly 2-fold risk for HF hospitalization or death after adjustment for other risk factors (RR, 1.95).

  9. Not surprisingly, because of the strong association between diabetes and HF, the 2 commonly coexist. • unselected community-based samples of patients with HF likely provide more accurate estimates of the prevalence of diabetes in the population.

  10. In patients with incident HF in Olmsted County, Minnesota, from 1979 –2000, the prevalence of diabetes was 24%. • In a nationally representative sample of Medicare beneficiaries hospitalized with principal discharge diagnosis of HF, Havranek and colleagues found a prevalence of diabetes exceeding 38%.

  11. diabetes is also a risk factor for the progression of HF

  12. Studies of Left Ventricular Dysfunction (SOLVD) trial • Das and colleagues found that in patients with asymptomatic ischemic cardiomyopathy, diabetes was a risk factor for the development of HF symptoms (hazard ratio [HR], 1.56), HF hospitalization (RR, 2.16), or the composite of death or symptom development (HR, 1.50). • This relation was not observed in patients with nonischemic cardiomyopathies.

  13. diabetes as an important predictor of mortality in patients with HF • Several studies, including clinical trials and community-based samples, have identified diabetes as an important predictor of mortality in patients with HF independent of other prognostic factors, including comorbidity and functional status.

  14. These studies collectively represent a wide range of patients, including those hospitalized for HF, ambulatory patients, those enrolled in clinical trials, and those with and without LVSD.

  15. those hospitalized for HF • Gustafsson and his colleague did a study which was an analysis of survival data comprising 5,491 patients consecutively hospitalized with new or worsening HF and screened for entry into the Danish Investigations of Arrhythmia and Mortality on Dofetilide (DIAMOND).

  16. those hospitalized for HF

  17. Gustafsson et al. JACC Vol 43, No 5, 2004; 771-7

  18. ambulatory patients • All patients with HF and left ventricular systolic dysfunction attending the outpatient clinic at our Veteran’s Hospital between October 1999 and November 2000 were enrolled in our study and followed prospectively. Electronic medical records were accessed for data on comorbid conditions, medications, echocardiogram results and mortality information. Mean follow-up was 2.7 years.

  19. Some studies suggest that this association may vary on the basis of patient sex or HF cause. • Specifically, some investigators have found that diabetes has greater prognostic importance in women or in those with ischemic cardiomyopathies.

  20. In summary, diabetes and HF commonly coexist. Diabetes is an important risk factor for the development of HF independent of CAD, hypertension, and other potential confounders of the association.

  21. Finally, diabetes is associated with the progression of and with a higher rate of adverse outcomes from HF. • These observations emphasize the need for the appropriate application of interventions that improve outcomes in this high-risk population.

  22. Thank you!

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