Heart failure patients with diabetes may benefit from higher glucose levels
Advanced heart failure patients with diabetes with the higher levels of glycosylated hemoglobin had better survival outcomes and less need for urgent heart transplants. Credit: University of California Los Angeles
Lowering glucose levels for people with diabetes is normally critical to improving health outcomes. But for those with heart failure, that might not always be the case, say UCLA researchers.
Currently published online in the American Journal of Cardiology, UCLA researchers compared levels of a marker used to track glucose levels called glycosylated hemoglobin in advanced heart failure patients with and without diabetes. The marker is gauged through a simple blood test.
The study assessed the relationship between levels of the marker and mortality outcomes. Researchers found that for heart failure patients with diabetes, for every unit increase in the marker, there was a 15 percent decrease in mortality.
"We were surprised that the optimal level of glycosylated hemoglobin in this patient population with diabetes was higher than levels in current treatment guidelines," said senior author Dr. Tamara Horwich, assistant professor of cardiology, David Geffen School of Medicine at UCLA. "We may find that doctors who treat patients who have both advanced heart failure and diabetes may not need to focus on aggressively lowering blood sugar, but rather keep it under moderate control."
Approximately 25 to 50 percent of patients with heart failure also have diabetes, compared to just 7 percent of the general population. The relation could be due to similar physiologic processes that underlie both conditions such as oxidative stress, patterns of hormonal activity and vascular lining dysfunction that can lead to conditions like atherosclerosis.
For the study, researchers assessed medical records of 845 patients with advanced heart failure, referred to a single university center, the Ahmanson-UCLA Cardiomyopathy Center. Most of the patients (72 percent) were men and the average age was 55.
Patients were classified as having diabetes or not and also grouped by four levels of glycosylated hemoglobin. Using statistical analysis, researchers calculated risk of death or need for an urgent heart transplant.
"For heart failure patients with diabetes, we found that higher, not lower levels, of the marker had better outcomes," said first author Sofia Tomova, a medical student in the division of cardiology, Geffen School of Medicine.
Researchers found that for diabetic heart failure patients, two-year event-free survival was highest amongst patients with the highest elevated glycosylated hemoglobin levels: 65 percent survival rate for patients with level four (greater than 8.6 percent of the marker) and 61 percent survival rate with level three (7.3 to 8.5 percent of the marker).
Patients with lower levels of the marker had worse survival rates: 48 percent survival rate for patients with level one (less than 6.4 percent of the marker) and 42 percent survival rate with level two (6.5 to 7.2 percent of the marker).
According to researchers, the ideal level of glycosylated hemoglobin in heart failure patients with diabetes appeared to be in the 8.3 to 8.9 percent range. Current national treatment targets aim much lower at 7 percent.
In the heart failure patients without diabetes, there was no significant mortality risk difference between the glycosylated hemoglobin levels.
Researchers note that for those without heart failure, having diabetes and elevated glycosylated hemoglobin levels is a risk factor for developing the condition. However, the study shows that if a patient already has heart failure, having higher glycosylated hemoglobin levels may be protective.
The next steps are studies to test the optimal glucose management goals as well as assess the best anti-diabetic medications for heart failure patients with diabetes.
Heart failure affects six million in the United States alone and is caused by weakened heart muscle function that can cause build-up of fluid in the lungs and other organs due to the heart's inability to pump effectively.
Provided by University of California - Los Angeles
- Extreme glucose levels in diabetic patients with heart failure linked to increase risk of deaths Jul 20, 2009 | not rated yet | 0
- Study shows metformin is safe for patients with advanced heart failure and diabetes mellitus Jan 07, 2010 | not rated yet | 0
- Elevated glucose associated with undetected heart damage Feb 02, 2012 | not rated yet | 0
- Standard test for blood sugar control not accurate in diabetic dialysis patients Feb 20, 2008 | not rated yet | 0
- New research says heart failure worse when right ventricle goes bad Feb 16, 2010 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Calculating on-axis elements of a solenoid
9 hours ago I wanted to mention that this solenoid has many winds over many layers. The thickness of the windings is 2.4 inches coming off of the engineering...
latitude & longitude & air pressure
10 hours ago Hi there, I have a peculiar question. Imagine that you are in a earth position, obtained by google, that gives you the latitude and longitude....
Differences of Classical Mechanics when learned with Calc vs algebra?
13 hours ago what are the differences? Every example I find usually has a derivative or integral or some kind of calculus defined concept that seems to make it...
what is the distance traveled
17 hours ago A rough sketch of experiment. Image: http://i43.tinypic.com/14t4sk5.png the red dots represent a side view of path traveled, F is downward force...
Image of a Convex Lens Cut in Half Horizontally
21 hours ago Hello everyone, A friend of mine came up with this question in class and I really do not have a good answer. Suppose you have a convex lens...
Ray tracing through optical system of thick lenses
21 hours ago Can you advise me a free software that allow to draw rays passed throught system of thick lenses (preferable in 3D)?
- More from Physics Forums - Classical Physics
More news stories
Costs to treat stroke are projected to more than double and the number of people having strokes may increase 20 percent by 2030, according to the American Heart Association/American Stroke Association.
Cardiology 18 hours ago | not rated yet | 0
Blood thinners are the preferred treatment option to prevent heart attacks, blood clots and stroke, but they are not without risk, and not just because of their side effects. These high-risk drugs, known as anticoagulants, ...
Cardiology 21 hours ago | not rated yet | 0
Results from a large observational study reported at EuroPCR 2013 today question whether bivalirudin is superior to heparin in the absence of GPIIb/IIIa blockade, showing similar 30-day mortality in patients with non-ST segment ...
Cardiology 21 hours ago | not rated yet | 0
The DESolve bioresorbable coronary scaffold system achieves good efficacy and safety with low rates of late lumen loss and major coronary adverse events at six months, show first results from the pivotal DESolve Nx trial ...
Cardiology 21 hours ago | not rated yet | 0
The Orsiro stent, which is a novel stent platform eluting sirolimus from a biodegradable polymer, demonstrated non-inferiority to the Xience Prime everolimus-eluting stent for the primary angiographic endpoint of in-stent ...
Cardiology May 21, 2013 | 5 / 5 (1) | 0
US teen births have dropped to a record low, but the country still has one of the highest rates among developed nations, the US Centers for Disease Control and Prevention said Thursday.
7 minutes ago | not rated yet | 0
Swiss scientists reveal the mechanism responsible for aging hidden deep within mitochondria—and dramatically slow it down in worms by administering antibiotics to the young.
17 hours ago | 4.9 / 5 (9) | 1 |
Researchers from Queen Mary, University of London have led the largest sequencing study of human disease to date, investigating the genetic basis of six autoimmune diseases.
17 hours ago | 4.7 / 5 (3) | 0 |
Until now, little was scientifically known about the human potential to cultivate compassion—the emotional state of caring for people who are suffering in a way that motivates altruistic behavior.
14 hours ago | 5 / 5 (2) | 2 |
Existing research shows that bicyclists who wear helmets have an 88 percent lower risk of brain injury, but researchers at Boston Children's Hospital found that simply having bicycle helmet laws in place showed a 20 percent ...
6 hours ago | not rated yet | 0
(HealthDay)—Migraines and depression can each cause a great deal of suffering, but new research indicates the combination of the two may be linked to something else entirely—a smaller brain.
14 hours ago | 4 / 5 (2) | 0 |