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Comparison of Outcomes in Patients With Diabetes Mellitus Treated With Versus Without Insulin + Heart Failure With Preserved Left Ventricular Ejection Fraction (from the TOPCAT Study).
- Source :
-
The American journal of cardiology [Am J Cardiol] 2019 Feb 15; Vol. 123 (4), pp. 611-617. Date of Electronic Publication: 2018 Nov 24. - Publication Year :
- 2019
-
Abstract
- We aimed to evaluate the impact of diabetes mellitus (DM) and insulin treatment on clinical outcomes in patients with heart failure and preserved left ventricular ejection fraction enrolled in the TOPCAT study. We investigated the influence of DM status (insulin-treated [ITDM], non-insulin treated [NITDM], and no diabetes [non-DM]) at baseline on time to development of the primary end point, a composite of cardiovascular (CV) mortality, heart failure hospitalization, and aborted cardiac arrest. Secondary end points included the individual components of the primary end point, myocardial infarction, stroke, all-cause mortality, hyperkalemia, and worsened renal function. Due to marked regional differences in characteristics and outcomes of the TOPCAT patients, with much lower events in patients enrolled in Russia/Georgia, we restricted our analyses on findings from patients enrolled from the Americas. Compared to patients without DM, patients with ITDM had approximately 2-fold increased risk for the primary end point, heart failure hospitalization, and myocardial infarction (hazard ratios: 1.80, 1.97, and 2.27, respectively) and approximately 50% increases in all-cause and CV mortality. The risks for these outcomes were also increased in patients with ITDM in comparison to patients with NITDM as well (hazard ratios: 1.63, 1.65, and 2.73, respectively, and approximately 40% increases in all-cause and CV mortality). Patients with NITDM had similar risks for the primary end point and all secondary end points as patients without DM. In conclusion, the apparent increased risk of adverse outcomes in patients with heart failure and preserved left ventricular ejection fraction and ITDM merits future research to improve the prognosis of these high-risk patients.<br /> (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Case-Control Studies
Diabetes Mellitus, Type 1 drug therapy
Diabetes Mellitus, Type 1 mortality
Diabetes Mellitus, Type 2 drug therapy
Diabetes Mellitus, Type 2 mortality
Female
Heart Failure mortality
Hospitalization
Humans
Male
Middle Aged
Mineralocorticoid Receptor Antagonists therapeutic use
Spironolactone therapeutic use
Stroke Volume
Survival Rate
Treatment Outcome
Diabetes Mellitus, Type 1 complications
Diabetes Mellitus, Type 2 complications
Heart Failure complications
Heart Failure therapy
Hypoglycemic Agents therapeutic use
Insulin therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1913
- Volume :
- 123
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- The American journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 30612727
- Full Text :
- https://doi.org/10.1016/j.amjcard.2018.11.022