A propensity-matched study of the effect of diabetes on the natural history of heart failure: variations by sex and age.
Pubmed ID: 17488764
Pubmed Central ID: PMC2095739
Journal: Heart (British Cardiac Society)
Publication Date: 12/01/2007
Affiliation: University of Alabama at Birmingham and VA Medical Center, Birmingham, AL 35294-2041, USA. firstname.lastname@example.org
MeSH Terms: Humans, Male, Female, Age Factors, Middle Aged, Randomized Controlled Trials as Topic, Sex Factors, Heart Failure, Hospitalization, Multivariate Analysis, Prognosis, Alabama, Diabetic Angiopathies
Grants: K23 AG019211, K23 AG019211-03, R01 HL085561, 1-R01-HL085561-01, K23 AG019211-04, P50-HL077100, R01 HL085561-01, 1-K23-AG19211-04, R01 HL085561-02, P50 HL077100
Authors: Love TE, Ahmed A, Ovalle F, Aban IB, Vaccarino V, Lloyd-Jones DM, Goff DC, Zhao J, Ritchie C, Gambassi G, Dell'Italia LJ
Cite As: Ahmed A, Aban IB, Vaccarino V, Lloyd-Jones DM, Goff DC Jr, Zhao J, Love TE, Ritchie C, Ovalle F, Gambassi G, Dell'Italia LJ. A propensity-matched study of the effect of diabetes on the natural history of heart failure: variations by sex and age. Heart 2007 Dec;93(12):1584-90. Epub 2007 May 8.
- Digitalis Investigation Group (DIG)
- Systolic Blood Pressure Intervention Trial (SPRINT)
- Systolic Blood Pressure Intervention Trial Primary Outcome Paper (SPRINT-POP) Data
BACKGROUND: Poor prognosis in heart failure (HF) patients with diabetes is often attributed to increased co-morbidity and advanced disease. Further, this effect may be worse in women. OBJECTIVE: To determine whether the effect of diabetes on outcomes and the sex-related variation persisted in a propensity score-matched HF population, and whether the sex-related variation was a function of age. METHODS: Of the 7788 HF patients in the Digitalis Investigation Group trial, 2218 had a history of diabetes. Propensity score for diabetes was calculated for each patient using a non-parsimonious logistic regression model incorporating all measured baseline covariates, and was used to match 2056 (93%) diabetic patients with 2056 non-diabetic patients. RESULTS: All-cause mortality occurred in 135 (25%) and 216 (39%) women without and with diabetes (adjusted HR = 1.67; 95% CI = 1.34 to 2.08; p<0.001). Among men, 535 (36%) and 609 (41%) patients without and with diabetes died from all causes (adjusted HR = 1.21; 95% CI = 1.07 to 1.36; p = 0.002). Sex-diabetes interaction (overall adjusted p<0.001) was only significant in patients > or = 65 years (15% absolute risk increase in women; multivariable p for interaction = 0.005), but not in younger patients (2% increase in women; p for interaction = 0.173). Risk-adjusted HR (95% CI) for all-cause hospitalisation for women and men were 1.49 (1.28 to 1.72) and 1.21 (1.11 to 1.32), respectively, also with significant sex-diabetes interaction (p = 0.011). CONCLUSIONS: Diabetes-associated increases in morbidity and mortality in chronic HF were more pronounced in women, and theses sex-related differences in outcomes were primarily observed in elderly patients.