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Heart failure may increase risk of new-onset type 2 diabetes
Diabetes is associated with twofold increased risk of HF in men, fivefold increased risk in women.
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Previous studies have shown that patients with diabetes are at a significantly increased risk of developing heart failure, but new studies indicate the reverse might also be true: Nondiabetic patients with heart failure may be at a heightened risk of developing new-onset diabetes.
At the American College of Cardiology Scientific Session 2006, Gregg C. Fonarow, MD, professor of medicine at the University of California, Los Angeles, spoke about the link between heart failure and type 2 diabetes.
Although many patients with diabetes are aware that they are at an increased risk for heart failure, many do not know the extent of the severity of this risk.
“Patients with diabetes are at a great excess risk of developing new-onset heart failure compared to their nondiabetic peers,” Fonarow said. “Men with diabetes are two times more likely to develop heart failure; women with diabetes are five times more likely. This risk is even greater in younger patients with diabetes.”
Diabetes increases risk
Fonarow cited data from the Framingham Heart Study showing that in patients with diabetes, glycemic control was a predictor of heart failure risk. Those patients in the lowest category of glycemic control were at the highest risk of developing new-onset heart failure.
“Studies of hospital registries have shown that as many as 44% of patients with heart failure may have diagnosed diabetes,” Fonarow said. “It is estimated that 2 million Americans may have both diabetes and heart failure.”
More to the link
Recent evidence indicates that there may be more to the link between diabetes and heart failure. “Some recent data suggest that heart failure in and of itself may lead to insulin resistance and an increased risk of type 2 diabetes,” Fonarow said.
Fonarow said one recent study examining the risk of diabetes among patients with heart failure found that fasting insulin was, on average, 300% higher in these patients than it was in a healthy control group. Furthermore, there was a 70% reduction in insulin sensitivity among patients with heart failure.
A second study examined patients with a greater severity of heart failure; this study showed these patients had a 70% increased risk of developing new-onset type 2 diabetes compared to patients who were nondiabetic at baseline.
The combination of heart failure and diabetes is associated with a significantly increased risk of major adverse cardiovascular events and mortality.
Despite this, Fonarow said appropriate treatments can significantly reduce the risk in this patient population.
He said a study he worked on at UCLA demonstrated that patients treated with oral agents had a reduced risk compared to those treated with insulin.
Fonarow recommended treatment with beta-blockers or ACE inhibitors for patients with diabetes and heart failure.
“Multiple randomized clinical trials have demonstrated that ACE inhibitors or angiotensin II receptor antagonists and evidence based beta-blockers are effective in patients with both diabetes and heart failure,” he said. “These drugs can prolong life for this important patient population.” – by Jay Lewis
For more information:
- Fonarow G. Heart failure in the diabetic patient. Presented at the American College of Cardiology Scientific Session 2006. March 11-14, 2006. Atlanta.