Heart Failure: A Serious and Common Comorbidity of Diabetes

In the 45to 74-year-old group of the Framingham Study,1 heart failure (HF) was twice as common in diabetic men and five times more common in diabetic women as it was in nondiabetic subjects and in patients under age 65. HF was fourfold higher in diabetic males and eightfold higher in diabetic females. In a health maintenance organization of almost 10,000 type 2 diabetic subjects, 12% initially had HF, and HF developed at a rate of 3.3% per year in the remainder. The incidence of heart failure increases with age.2 In a 43month nursing home study, of residents without heart failure,3 39% of diabetic residents (10.9% per year) and 23% of nondiabetic residents (6.4% per year) developed HF. Conversely, the prevalence of diabetes in HF patients is between 30 and 40%. This has been shown in an elderly Italian population, in patients admitted to hospital with HF, and in subjects in HF studies. Furthermore, HF has been shown to be an independent risk factor for the development of diabetes, and, in the U.K. Prospective Diabetes Study,5 the prevalence of HF was proportional to the hemoglobin A1c (A1C), with no upper or lower threshold. The prognosis for diabetic patients with HF is worse than that of nondiabetic HF patients. In the Studies of Left Ventricular Dysfunction (SOLVD) and Randomized Evaluation for Strategies of Left Ventricular Dysfunction trials, the presence of diabetes was an independent risk factor for death. In the Diabetes Insulin Glucose in Acute Myocardial Infarction (DIGAMI) study, HF account-