Diabetes is an independent risk factor for the development of CHF (Kannel etal., 1974; He etal., 2001; Thrainsdottir etal., 2005). In the Framingham study, for those between the ages of 45 and 74 years the presence of diabetes increased the risk of CHF in men by twofold and in women by fivefold (Kannel etal., 1974). This effect was even more apparent in the younger age group. Under the age of 65 years, diabetes increased the risk of developing CHF by four- and eightfold for men and women, respectively. In the NHANES study, diabetes was an independent risk factor for CHF with a hazard ratio of 1.85 (1.51-2.28, P< 0.001) (He etal., 2001). In Iceland, the age-adjusted odds ratio for development of CHF in those with diabetes compared to those without diabetes was 2.8 (2.2-3.6) (Thrainsdottir etal., 2005), and several other studies have identified diabetes as an independent risk factor for CHF (Aronow and Ahn, 1999; Chen etal., 1999; Iribarren etal., 2001).
In populations with diabetes there are identifiable risk factors for the development of CHF. These include increased HbAlc (Stratton etal., 2000; Iribarren etal., 2001; Vaur etal., 2003; Nichols etal., 2004) and increased body mass index (BMI). An increased BMI in patients with diabetes predicts development of CHF, and a 2.5 unit increase in BMI increases the risk of CHF by 12% (Nichols etal., 2004). As noted above in the UKPDS population, the incidence of CHF increased with HbAlc. For every 1% reduction in HbAlc, the risk of CHF was seen to fall by 16% (Stratton etal., 2000).
Other independent risk factors for CHF in patients with diabetes are increasing age, coronary heart disease (CHD), use of insulin, retinopathy, proteinuria, nephropathy, end-stage renal disease and duration of diabetes (Vaur etal., 2003; Bertoni etal., 2004; Nichols etal., 2004; Wong etal., 2005).
The two most important risk factors for the development of CHF are CHD and hypertension. These conditions are more prevalent in the patients with diabetes than in those without diabetes. A meta-analysis including 447 064 patients with diabetes estimated the rate of fatal CHD to be 5.4% in those with diabetes compared to 1.6% in those without (Huxley etal., 2006). The prevalence of hypertension in those with diabetes is approximately double that in those without (Simonson, 1988) (see also Chapter 6).
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Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...