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Patients with heart failure, moderately controlled diabetes at lower risk for death

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Researchers have found what appears to be a U-shaped association between mortality and HbA1c in patients with diabetes and heart failure — patients with modest glucose control had the lowest risk for death.

“Most doctors try to keep glucose levels of those with diabetes as low as they can to lower the risk for complications such as eye problems, kidney disease or the development of heart disease,” David Aguilar, MD, associate professor of medicine in the department of cardiology at Baylor College of Medicine, said in a press release. “However, we found that in diabetic patients with HF, glucose levels slightly higher than what are normally recommended had the lowest risk for death.”

Researchers assessed the association between HbA1c and mortality in 5,815 veterans (94% men; mean age 69.2) with diabetes and HF who received treatment at a Veterans Affairs medical center. Patients were divided into five increasing quintile groups based upon HbA1c levels:

• Quintile 1: <6.4%
• Quintile 2: 6.4%-7.1%
• Quintile 3: 7.1%-7.8%
• Quintile 4: 7.8%-9%
• Quintile 5: >9%

At two years, patients with modest glucose control had the lowest risk for death (17.7%) compared with patients in the other four quintiles.

• Quintile 1 risk-adjusted HR=1.37; P=.001.
• Quintile 2 risk-adjusted HR=1.31; P=.004.
• Quintile 4 risk-adjusted HR=1.31; P=.004.
• Quintile 5 risk-adjusted HR=1.45; P<.001.

Increased levels of HbA1c were associated with an increased incidence for HF hospitalization.

Hospitalizations for any cause during follow-up occurred in 43.5% of quintile 1 patients, 42.6% of quintile 2 patients, 45.1% of quintile 3 patients, 47.1% of quintile 4 patients and 51.6 % of quintile 5 patients. There was an overall trend toward increased all-cause hospitalization in quintile 5 when compared with quintile 1 (risk-adjusted HR=1.12; P=.08).

“Future appropriately designed studies are necessary to confirm our findings and expand on potential mechanisms contributing to the increased hazard,” the researchers wrote.

Aguilar.J Am Coll Cardiol. 2009; 54:422-428.