TY - JOUR
T1 - Impaired glucose tolerance and albuminuria in patients with chronic heart failure
T2 - a subanalysis of the SUPPORT trial
AU - Nochioka, Kotaro
AU - Sakata, Yasuhiko
AU - Miura, Masanobu
AU - Shiroto, Takashi
AU - Takahashi, Jun
AU - Saga, Chie
AU - Ikeno, Yasuko
AU - Shiba, Nobuyuki
AU - Shinozaki, Tsuyoshi
AU - Sugi, Masafumi
AU - Nakagawa, Makoto
AU - Komaru, Tatsuya
AU - Kato, Atsushi
AU - Nozaki, Eiji
AU - Iwabuchi, Kaoru
AU - Hiramoto, Tetsuya
AU - Inoue, Kanichi
AU - Ohe, Masatoshi
AU - Tamaki, Kenji
AU - Tsuji, Ichiro
AU - Shimokawa, Hiroaki
N1 - Funding Information:
The SUPPORT trial was carried out, supported by grants‐in‐aid from the Ministry of Health, Labour and Welfare and from the Ministry of Education, Culture, Sports, Science and Technology, Japan (KAKENHI‐PROJECT‐17K15821).
Publisher Copyright:
© 2019 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - Aims: The study aims to evaluate the prognostic significance of impaired glucose tolerance (IGT) with reference to albuminuria in patients with chronic heart failure (CHF). Methods and results: We examined 535 CHF patients (mean 66 years, women 25%) in the control arm of our SUPPORT trial, in which we examined additive impact of olmesartan in hypertensive patients with symptomatic CHF treated with β-blockers and/or angiotensin-converting enzyme inhibitors. We examined the association between glycaemic abnormality (assessed by 75 g of oral glucose tolerance test) and albuminuria for a composite outcome of all-cause death, myocardial infarction, stroke, and HF hospitalization. IGT patients (N = 113, mean 67.2 years) were older and more frequently treated with β-blockers compared with those with normal glucose regulation (N = 142, mean 64.0 years) and those with diabetes mellitus (N = 280, mean 65.7 years). Multivariable Cox proportional hazard models revealed that, as compared with normal glucose regulation (NGR), IGT was associated with increased risk of the outcome when complicated by albuminuria [hazard ratio (HR) 2.25; 95% confidence interval (CI) 1.14–4.42; P = 0.019] but not when uncomplicated by albuminuria (HR 0.76; 95% CI 0.35–1.60, P = 0.47) (P for interaction = 0.041). This was also the case for diabetes mellitus and albuminuria (HR 2.06; 95% CI 1.17–3.61; P = 0.012). Among IGT patients without albuminuria, 21 (29%) developed albuminuria at 1-year visit, which was again associated with poor prognosis (HR 7.36; 95% CI 1.39–38.98, P = 0.019). Conclusions: These results indicate that IGT is associated with poor prognosis when complicated by albuminuria in CHF patients, demonstrating the importance of combined early stages of glucose intolerance and renal dysfunction in the management of CHF.
AB - Aims: The study aims to evaluate the prognostic significance of impaired glucose tolerance (IGT) with reference to albuminuria in patients with chronic heart failure (CHF). Methods and results: We examined 535 CHF patients (mean 66 years, women 25%) in the control arm of our SUPPORT trial, in which we examined additive impact of olmesartan in hypertensive patients with symptomatic CHF treated with β-blockers and/or angiotensin-converting enzyme inhibitors. We examined the association between glycaemic abnormality (assessed by 75 g of oral glucose tolerance test) and albuminuria for a composite outcome of all-cause death, myocardial infarction, stroke, and HF hospitalization. IGT patients (N = 113, mean 67.2 years) were older and more frequently treated with β-blockers compared with those with normal glucose regulation (N = 142, mean 64.0 years) and those with diabetes mellitus (N = 280, mean 65.7 years). Multivariable Cox proportional hazard models revealed that, as compared with normal glucose regulation (NGR), IGT was associated with increased risk of the outcome when complicated by albuminuria [hazard ratio (HR) 2.25; 95% confidence interval (CI) 1.14–4.42; P = 0.019] but not when uncomplicated by albuminuria (HR 0.76; 95% CI 0.35–1.60, P = 0.47) (P for interaction = 0.041). This was also the case for diabetes mellitus and albuminuria (HR 2.06; 95% CI 1.17–3.61; P = 0.012). Among IGT patients without albuminuria, 21 (29%) developed albuminuria at 1-year visit, which was again associated with poor prognosis (HR 7.36; 95% CI 1.39–38.98, P = 0.019). Conclusions: These results indicate that IGT is associated with poor prognosis when complicated by albuminuria in CHF patients, demonstrating the importance of combined early stages of glucose intolerance and renal dysfunction in the management of CHF.
KW - Albuminuria
KW - Chronic heart failure
KW - Diabetes mellitus
KW - Impaired glucose tolerance
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U2 - 10.1002/ehf2.12516
DO - 10.1002/ehf2.12516
M3 - Article
C2 - 31647614
AN - SCOPUS:85074618388
SN - 2055-5822
VL - 6
SP - 1252
EP - 1261
JO - ESC heart failure
JF - ESC heart failure
IS - 6
ER -