Chronic heart failure is more common in patients with diabetes than in those without diabetes. In the NHANES and Framingham studies, the incidence of CHF in patients with diabetes was two- and fourfold higher than in patients without diabetes (Kannel etal., 1974; He etal., 2001). A UK case-control study also found that both male and female patients with diabetes have a twofold greater risk of developing CHF than those without diabetes (Johansson etal., 2001).
In the USA, a retrospective study of 9951 patients with diabetes, matched with patients without diabetes, found an incidence of CHF in patients with diabetes 2.5 times that of those without diabetes (30.9 vs. 12.4 cases per 1000 person-years) (Nichols etal., 2004). In a UK population of patients with diabetes, the incidence of CHF was 21 cases per 1000 person-years (Maru etal., 2005).
Over 4 years, 39% of elderly nursing home residents with diabetes developed CHF compared to 23% of those without (Aronow and Ahn, 1999). This high incidence rate in the elderly was confirmed by a large US cohort study in 115 803 patients with diabetes over 64 years old (12.6 cases of incident CHF per 100 person-years) (Bertoni et al., 2004).
Incidence of CHF in clinical trials of patients with diabetes
Clinical trial populations are very different from real-life patient cohorts. The UKPDS included patients with a mean age of 53 years with newly diagnosed diabetes (UK Prospective Diabetes Study (UKPDS) Group, 1998). The incidence of CHF was 2.3 per 1000 person-years for those with an HbA1c of < 6 and 11.9 per 1000 person-years for those with an HbA1c of > 10 (Stratton etal., 2000).
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