High-Normal Glucose Boosts Heart Failure Risk

Glucose levels at the top end of the normal range increase the congestive heart failure (CHF) hazard for patients already at high risk, according to two international studies.

Researchers from Sweden, Canada, England, Germany, and Australia looked at the associations between fasting plasma glucose level and risk of hospitalization for CHF during follow-up in patients who were enrolled in two clinical trials of the antihypertensive agent telmisartan (an angiotensin II receptor antagonist; ARB) used in the management of hypertension. The cohort of over 31,000 patients, all with one or more coronary, peripheral, or cerebrovascular diseases, or diabetes with end-organ damage had baseline fasting plasma glucose levels measured. The researchers conducted interim analyses blinded for randomized treatment to compare baseline glucose with the adjusted CHF event rate at a mean follow-up of 886 days. The mean age of the patients was 67, and 69% were men. Of the total 31,546 patients, 37% had a diabetes diagnosis prior to enrollment, and 3.2% were newly diagnosed with diabetes at study entry.

The researchers found that during follow-up in the two trials, there were 2,882 primary events, including 1,067 cardiovascular deaths, 926 myocardial infarcts (MI), 823 strokes, and 668 hospitalizations for CHF. After controlling for age and sex, each increase of one mmol/l (18 mg/dl) in fasting plasma glucose was associated with a 1.10-fold-increased risk of hospitalization for CHF. The association between glucose and congestive heart failure hospitalization persisted when the investigators controlled for the additional factors of smoking, previous myocardial infarction, hypertension, waist-to-hip ratio, creatinine, diabetes, and use of aspirin, â-blockers, or statins. Each one mmol/l rise increased the risk for the composite endpoint by 9% for all patients, 3% for patients without diabetes, and 5% for patients with diabetes.

"You can look at blood glucose much like blood pressure or cholesterol,” said lead author Claes Held, M.D., Ph.D., of the Karolinska University Hospital (Stockholm, Sweden). "Even if you have normal blood glucose, there is a gradual increase in risk wherever you start on the scale. If the blood sugar is 'high normal,' there is a higher risk than those with 'low normal' fasting blood glucose levels.”


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Karolinska University Hospital