Glycemic control and heart failure among adult patients with diabetes

Background-Glycemic control is associated with microvascular events, but it s effect on the risk of heart failure is not well understood. We examined t he association between hemoglobin (Hb) A(1c) and the risk of heart failure hospitalization and/or death in a population-based sample of adult patients with diabetes and assessed whether this association differed by patient se x, heart failure pathogenesis, and hypertension status. Methods and Results-A cohort design was used with baseline between January 1, 1995, and June 30, 1996, and fellow-up through December 31, 1997 (median 2.2 years). Participants were 25 958 men and 22 900 women with (predominan tly type 2) diabetes, greater than or equal to 19 years old, with no known history of heart failure. There were a total of 935 events (516 among men; 419 among women). After adjustment for age, sex, race/ethnicity, education level, cigarette smoking, alcohol consumption, hypertension, obesity, use o f beta -blockers and ACE inhibitors, type and duration of diabetes, and inc idence of interim myocardial infarction, each 1% increase in Hb A(1c) was a ssociated with an 8% increased risk of heart failure (95% CI 5% to 12%). An Hb A(1c) greater than or equal to 10, relative to Hb A(1c) <7, was associa ted with 1.56-fold (95% CI 1.26 to 1.93) greater risk of heart failure. Alt hough the association was stronger in men than in women, no differences exi sted by heart failure pathogenesis or hypertension status. Conclusions-These results confirm previous evidence that poor glycemic cont rol may be associated with an increased risk of heart failure among adult p atients with diabetes.