Heart failure
A Propensity-Matched Study of the Association of Diabetes Mellitus With Incident Heart Failure and Mortality Among Community-Dwelling Older Adults

https://doi.org/10.1016/j.amjcard.2011.07.046Get rights and content

Diabetes mellitus (DM) is a risk factor for incident heart failure (HF) in older adults. However, the extent to which this association is independent of other risk factors remains unclear. Of 5,464 community-dwelling adults ≥65 years old in the Cardiovascular Health Study without baseline HF, 862 had DM (fasting plasma glucose levels ≥126 mg/dl or treatment with insulin or oral hypoglycemic agents). Propensity scores for DM were estimated for each of the 5,464 participants and were used to assemble a cohort of 717 pairs of participants with and without DM who were balanced in 65 baseline characteristics. Incident HF occurred in 31% and 26% of matched participants with and without DM, respectively, during >13 years of follow-up (hazard ratio 1.45 for DM vs no DM, 95% confidence interval [CI] 1.14 to 1.86, p = 0.003). Of the 5,464 participants before matching unadjusted and multivariable-adjusted hazard ratios for incident HF associated with DM were 2.22 (95% CI 1.94 to 2.55, p <0.001) and 1.52 (95% CI 1.30 to 1.78, p <0.001), respectively. All-cause mortality occurred in 57% and 47% of matched participants with and without DM, respectively (hazard ratio 1.35, 95% CI 1.13 to 1.61, p = 0.001). Of matched participants DM-associated hazard ratios for incident peripheral arterial disease, incident acute myocardial infarction, and incident stroke were 2.50 (95% CI 1.45 to 4.32, p = 0.001), 1.37 (95% CI 0.97 to 1.93, p = 0.072), and 1.11 (95% CI 0.81 to 1.51, p = 0.527), respectively. In conclusion, the association of DM with incident HF and all-cause mortality in community-dwelling older adults without HF is independent of major baseline cardiovascular risk factors.

Section snippets

Methods

The Cardiovascular Health Study (CHS) is a National Heart, Lung, and Blood Institute–funded prospective study designed to assess traditional and nontraditional cardiovascular risk factors in community-dwelling older adults.8 The CHS recruited 5,888 Medicare-eligible community-dwelling adults ≥65 years of age from 4 United States communities in 2 phases. A mostly white initial cohort of 5,201 participants (1989 through 1990) was later supplemented by 687 African-Americans from 3 of those 4

Results

Our matched cohort had a mean age ± SD of 73 ± 6 years, 51% were women, and 21% were African-American (Table 1). Before matching, participants with DM were more likely to have a history of coronary artery disease, hypertension, and stroke and higher mean serum insulin, triglyceride, interleukin-6, and C-reactive protein levels. These and other imbalances were balanced in the matched cohort (Figure 1, Table 1).

Incident HF occurred in 31% and 26% of matched participants with and without DM,

Discussion

Findings from the present propensity-matched study of community-dwelling older adults demonstrate that DM had a strong association with incident HF and all-cause mortality, and these associations were independent of most traditional and nontraditional cardiovascular risk factors at baseline. Results from the present study also demonstrate that the higher incidence of HF in those with DM was due in large part to a higher incidence of AMI in those subjects. In contrast to previous studies of the

Acknowledgment

The CHS was conducted and supported by the National Heart, Lung, and Blood Institute in collaboration with the CHS Investigators. This report was prepared using a limited-access dataset obtained by the National Heart, Lung, and Blood Institute and does not necessarily reflect the opinions or views of the CHS or the National Heart, Lung, and Blood Institute.

References (40)

  • P. Meyer et al.

    A propensity-matched study of elevated jugular venous pressure and outcomes in chronic heart failure

    Am J Cardiol

    (2009)
  • W.S. Aronow et al.

    A propensity-matched study of the association of peripheral arterial disease with cardiovascular outcomes in community-dwelling older adults

    Am J Cardiol

    (2009)
  • O.J. Ekundayo et al.

    Multimorbidity due to diabetes mellitus and chronic kidney disease and outcomes in chronic heart failure

    Am J Cardiol

    (2009)
  • P. Meyer et al.

    Digoxin and reduction of heart failure hospitalization in chronic systolic and diastolic heart failure

    Am J Cardiol

    (2008)
  • M. Banach et al.

    Relation of baseline systolic blood pressure and long-term outcomes in ambulatory patients with chronic mild to moderate heart failure

    Am J Cardiol

    (2011)
  • M. Mujib et al.

    Warfarin use and outcomes in patients with advanced chronic systolic heart failure without atrial fibrillation, prior thromboembolic events, or prosthetic valves

    Am J Cardiol

    (2011)
  • R.V. Desai et al.

    Effect of serum insulin on the association between hyperuricemia and incident heart failure

    Am J Cardiol

    (2010)
  • R.V. Desai et al.

    Impact of baseline systolic blood pressure on long-term outcomes in patients with advanced chronic systolic heart failure (insights from the BEST trial)

    Am J Cardiol

    (2010)
  • A. Ahmed et al.

    A history of systemic hypertension and incident heart failure hospitalization in patients with acute myocardial infarction and left ventricular systolic dysfunction

    Am J Cardiol

    (2009)
  • S. Normand et al.

    Validating recommendations for coronary angiography following acute myocardial infarction in the elderly: a matched analysis using propensity scores

    J Clin Epidemiol

    (2001)
  • Cited by (0)

    Dr. Ahmed is supported by the National Institutes of Health, Bethesda, Maryland through Grants R01-HL085561 and R01-HL097047 from the National Heart, Lung, and Blood Institute, Bethesda and a generous gift from Ms. Jean B. Morris of Birmingham, Alabama.

    View full text