Prevalence of diabetes in populations with CHF

General population studies

The prevalence of diabetes in populations with left ventricular systolic dysfunction (LVSD) varies from 6 to 25% (Table 5.1) (McDonagh etal., 1997; Morgan etal., 1999; Davies etal., 2001; Hedberg etal., 2001; Raymond etal., 2003; Redfield etal., 2003; Kistorp etal., 2005). In population studies of CHF, the prevalence of diabetes in patients with CHF was between 12 and 30% (Table 5.2) (Amato etal., 1997; Mosterd etal., 2001; Thrainsdottir etal., 2005). The absolute numbers of patients with diabetes who also suffer from CHF in these epidemiological studies are small, making further groupings by age and gender inaccurate.

Hospitalised populations

In populations of patients hospitalised with CHF, the prevalence of diabetes is greater than that found in general population studies (Table 5.3). The prevalence of diabetes

Table 5.1 The prevalence of diabetes in populations with and without left ventricular systolic dysfunction (LVSD).

Study and date

Type of

No. of

Age

Mean age

Definition

Prevalence

Prevalence of

Prevalence of

Prevalence of

study

participants

range (years)

(years)

of LVSD

of LVSD

symptomatic/ asymptomatic LVSD

diabetes in population with LVSD

diabetes in population without LVSD

ECHOES,

Epidemiological -

3960

>45

61

LVEF < 40%

1.8%

Symptomatic

Symptomatic

= 146(3.8%)

England 2001

primary

II

LVEF < 40%

LVEF< 40%

in population

(Davies etal..

care

h = 38(1%)

«=9(24%)

with

2001).

Asymptomatic LVEF < 40% «=34(0.9%)

Asymptomatic LVEF< 40% n = 2(6%)

LVEF > 40%

Copenhagen

Epidemiological -

764

50-89

66 (Median)

LVEF< 40%

n = 36

33%

LVEF < 40%

«=43(5.9%)

2003

primary care

(4.7%)

Asymptomatic

n = 5(1.2%)

(Raymond

(stratified by

etal, 2003)

age)

Poole. England

Epidemiological -

817

70-84

76

Qualitative

n = 61

79%

n = 6(10%)

,,=43(6%)

1999

primary

assessment

(7.5%)

Asymptomatic

(Morgan

care

(self-reported

etal, 1999)

history)

Table 5.1 Continued

Study and date

Type of

No. of

Age

Mean

Definition

Prevalence of

Prevalence of

Prevalence of

Prevalence of

study

participants

range (years)

(years)

of LVSD

LVSD

symptomatic/ asymptomatic LVSD

diabetes in population with LVSD

diabetes in population without LVSD

Glasgow 1997

Epidemiological

1640

25-74

50

LVEF<30%

n= 43(2.9%)

77% of

« = 14(12.4%)

« = 34(2.5%) in

(McDonagh

LVEF< 35%

« = 113(7.7%)

participants

population with

etal., 1997)

LVEF< 35% were asymptomatic

LVEF> 35%

Vasteras,

Epidemiological

412

75

75

LVWMI

n= 28(6.8%)

46%

n= 6(22%)

n = 27(7%)

Sweden 2001

<1.7%

Asymptomatic

(Hedberg

etal., 2001)

Olmsted, USA

Epidemiological

1888

>45

63

LVEF < 50%

n = 123(6.5%)

-

n =21(17%)

» = 130(6.8%)

2003

LVEF< 40%

n = 40(1.8%)

H =6(15%)

(Redfield

etal, 2003)

Copenhagen

Prospective,

188

-

69

LVEF< 45%

All had LVSD

All were

n =48(25.5%)

-

2005 (Kistorp

hospital heart

symptomatic

etal., 2005)

failure clinic

(LVEF = left ventricular ejection fraction, LVWMI = left ventricular wall motion index.)

(LVEF = left ventricular ejection fraction, LVWMI = left ventricular wall motion index.)

Table 5.2 The prevalence of diabetes in general populations with and without chronic heart failure (CHF).

Study

Date

No. of

Age

Mean

Prevalence

Prevalence of

Prevalence of

participants

range

age

of CHF

diabetes in

diabetes in

(years) (years)

population

population

with CHF

without CHF

Rotterdam

2001

5255

55-94

69

n = 181(3.4%)

n = 32(17.5%)

n = 523(10.3%)

(Mosterd

etal., 2001)

Italy (Amato

1997

1339

> 65

74

n = 125(9.5%)

n = 37(29.6%)

n = 160(13.2%)

etal., 1997)

Rekjavik

2005

19381

33-84

-

n = 733(3.8%)

n = 85(11.6%)

n = 635(3.4%)

(Thrainsdottir

etal., 2005)

Table 5.3 Prevalence of diabetes in patients hospitalised with chronic heart failure in ethnic subgroups.

Location

Year

Race

Mean age

No. of patients

Prevalence of diabetes

USA (Agoston

2004

White

70

183

48%

etal., 2004)

Black

66

144

37%

New Zealand

1996

European

-

-

17%

(Bhoopatkar

Maori

-

-

34%

and Simmons,

Pacific Isles

-

36%

1996)

UK (Blackledge

2003

Whites

78

5057

16%

etal., 2003)

South Asians

70

306

46%

USA (Vaccarino

2002

White

75

316

45%

etal., 2002)

African American

67

82

55%

USA (Deswal

2004

White

71

17 093

43%

etal., 2004)

Black

67

4901

41%

Malaysia (Chong

2003

Malay

61

45

22%

etal., 2003)

Chinese

67

27

19%

Indian

65

22

59%

USA (Rathore

2003

White

80

26 283

37%

etal., 2003)

Black

77

3449

48%

USA (Singh

2005

White

67

48

65%

etal., 2005)

Black

65

52

33%

is approximately 40% in the larger studies of patients hospitalised with CHF (Rathore etal., 2003; Deswal etal., 2004). Whether or not the prevalence of diabetes in CHF varies according to ethnic group is uncertain (Table 5.3). Most of the studies addressing this issue include small numbers of patients, and no consistent pattern is seen.

Table 5.4 Prevalence of diabetes in clinical trials of chronic heart failure.

Table 5.4 Prevalence of diabetes in clinical trials of chronic heart failure.

CONSENSUS (CONSENSUS

23

CHARM-Alt

27

Trial Study Group, 1987)

(Granger etal., 2003)

SOLVD-T (SOLVD

26

CHARM-Added

30

Investigators, 1991)

(McMurray etal., 2003)

SOLVD-P (SOLVD

15

ELITE-II (Pitt etal., 2000)

24

Investigators, 1992)

ATLAS (Ryden etal., 2000)

19

RESOLVD (RESOLVD Investigators, 2000)

25

MERIT-HF (MERIT-HF

25

Val-HeFT (Cohn etal.,

26

Study Group, 1999)

2001)

CIBIS II (Erdmann etal.,

12

A-HeFT

41

2001)

(Taylor etal., 2004)

COPERNICUS (Mohacsi

26

DIG (Digitalis Investigation

28

etal., 2001)

Group, 1997)

COMET (Poole-Wolson

24

COMPANION

41

etal., 2003)

(Bristow etal., 2004)

ANZ (Australia/New

19

SCD-HEFT (Bardy etal.,

30

Zealand Heart Failure

2005)

Research Collaborative

Group, 1997)

Clinical trials of CHF

Clinical trials of CHF

The prevalence of diabetes in clinical trials of CHF ranges from 12 to 41% (Table 5.4). These trials are highly selected and not representative of the general population with CHF, as patients are typically younger, with less co-morbidity.

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