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Heart Failure Risks: Control Serum Glucose to Reduce HF Risk in Diabetics
  MedPage Today
Published: June 01, 2010
BERLIN -- For patients with diabetes, moderate chronic kidney disease, and anemia, glycated hemoglobin (HbA1c) and estimated glomerular filtration rate (GFR) are independent risk factors for developing heart failure, researchers reported here.
Those findings emerged from a post hoc analysis of data from the Trial to Reduce Cardiovascular Events with Aranesp (TREAT) study, which revealed that the hazard ratio for developing heart failure was 1.11 for every 1% increase in HbA1c from baseline (P=0.002, 95% CI 1.04 to 1.19), said Eldrin F. Lewis, MD, of Harvard Medical School and Brigham and Women's Hospital in Boston.
For estimated GFR, heart failure risk decreased with every 1 unit increase from baseline (HR 0.99, 95% CI 0.98 to 1.00, P=0.047), Lewis reported in a late-breaking clinical poster presented here at the Heart Failure Congress.
Action Points
* This analysis suggests that tight management of modifiable risk factors such a HbA1c and estimated GRF may reduce the risk for developing heart failure in anemic patients with diabetes or chronic renal disease.
* Point out that these conclusions come from a post-hoc analysis and therefore can be considered hypothesis generating only.
* Note that this study was published as a poster and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
In an interview with MedPage Today, Lewis said the strongest independent predictor of heart failure among patients in the TREAT study was a history of heart failure (HR, 2.47 95% CI 1.98 to 3.07, P<0.001), followed by baseline loop diuretic use (HR 1.64, 95% CI 1.28 to 2.09, P<0.001), and history of myocardial infarction (HR 1.48, 95% CI 1.19 to 1.85 P<0.001).
But, he said the analysis indicated it is "the modifiable risk factors such as diabetes and estimated GFR that should be the focus of prevention efforts."
The TREAT study enrolled 4,038 patients with diabetes, chronic kidney disease (defined as estimated GFR of 20 to 60 mL/min/1.732) and anemia, defined as hemoglobin 11 g/dL. The patients were randomized to darbepoetin (Aranesp) or placebo and followed for a median of 29 months.
The median age of the patients was 68 and 57% were women. The median estimated GFR was 34 mL/min/ 1.732. Roughly 18% of the study population had a history of myocardial infarction and 10.7% had a confirmed history of heart failure.
Overall, 10.7% of the TREAT patients developed heart failure during follow-up. In this group, age, a history of heart failure, higher HbA1c, lower estimated GFR, a history of myocardial infarction, male gender, and baseline use of loop diuretics were independently associated with increased risk of acute heart failure or cardiovascular death.
Included in the 434 patients who developed heart failure, there was a subset of 173 patients who developed incident heart failure during follow-up.
Lewis said that when he and his colleagues analyzed data from this subset, they discovered similar patterns of risk factors as independent predictors.
The TREAT trial investigated the potential role for darbepoetin alfa (Aranesp) for treatment of patients with diabetes or chronic renal disease and anemia. The trial found no benefit for darbepoetin alfa but did reveal a doubling of the risk for stroke. In this analysis, there was no significant association between randomization to darbepoetin alfa and incident heart failure.
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