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Elevated blood glucose linked to early death, other events in patients with acute HF
Slight elevation in blood glucose was associated with early mortality, future diabetes and future hospitalization among patients with acute HF, even those without diabetes, in a recent study.
“Although diabetes is a known risk factor for developing [HF], this is the first time that it has been shown that [HF] predisposes people to developing diabetes,” researcher Douglas S. Lee, MD, PhD, FRCPC, said in a press release.
In a competing-risk analysis, Lee and colleagues evaluated 30-day mortality, new diabetes diagnoses and hospitalization outcomes in a population-based cohort of 16,524 patients (median age, 79 years; 49% men) who presented with acute HF in Ontario, Canada, between 2004 and 2007.
Patients were stratified by concentration of blood glucose at presentation: 3.9 mmol/L to 6.1 mmol/L, >6.1 mmol/L to 7.8 mmol/L, >7.8 mmol/L to 9.4 mmol/L, >9.4 mmol/L to 11.1 mmol/L and >11.1 mmol/L. Evaluated outcomes included death at 30 days and 1 year after presentation, CV readmissions, HF readmissions, diabetes-related hospitalizations among patients with pre-existing diabetes and new diabetes diagnoses in those without pre-existing diabetes.
Among 9,275 patients without diabetes, blood glucose >6.1 mmol/L at presentation was associated with increased risk for all-cause mortality (HR range=1.26 [95% CI, 1.05-1.5] to 1.5 [95% CI, 1.11-2.02]) and CV-related death (HR range=1.28 [95% CI, 1.03-1.59] to 1.64 [95% CI, 1.16-2.33]), Lee, senior scientist at the Institute for Clinical Evaluative Sciences, division of cardiology, University Health Network, University of Toronto, and colleagues found.
Among 7,249 patients with diabetes, blood glucose >11.1 mmol/L at presentation was associated with increased risk for all-cause mortality (HR=1.48; 95% CI, 1.1-2) and diabetes-related hospitalization (HR=1.39; 95% CI, 1.2-1.61), according to the researchers.
In all patients, blood glucose >9.4 mmol/L at presentation was associated with increased risk for HF- or CV-related hospitalization (HR range=1.09 [95% CI, 1.02-1.17] to 1.15 [95% CI, 1.07-1.24]), Lee and colleagues wrote.
Among those without diabetes at baseline, the risk for diagnosis of incident diabetes increased with the level of blood glucose at presentation (HR range=1.61 [95% CI, 1.39-1.87] for >6.1-7.8 mmol/L to 3.61 [95% CI, 2.78-4.68] for >11.1 mmol/L), the researchers found.
“Our findings suggest that the measurement of blood sugar levels in all patients arriving at [EDs] with acute [HF] could provide doctors with useful prognostic information and could help to improve outcomes in these patients,” Lee said in the press release. “It is a rapid, readily available and inexpensive test that could be used to enable doctors to quickly assess a patient’s risk for a wide range of possible outcomes and to suggest appropriate screening strategies that should be put in place.”
Disclosure: The study was supported by the Canadian Institutes of Health Research and the Heart and Stroke Foundation of Ontario. The researchers report no relevant financial disclosures.