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Prevalence and characteristics of diabetes mellitus and insulin resistance in heart failure patients across Europe. A report of the 1st Postgraduate Course in Heart Failure of the HFA.

Session Poster session 3

Speaker Stefania Paolillo

Congress : Heart Failure 2017

  • Topic : preventive cardiology
  • Sub-topic : Diabetes and the Heart
  • Session type : Poster Session
  • FP Number : P1879

Authors : S Paolillo (Naples,IT), C Minoia (Gallarate,IT), K Ablasser (Graz,AT), G Di Stolfo (San Giovanni Rotondo,IT), M Merlo (Trieste,IT), A Vachulova (Bratislava,SK), F Ruschitzka (Zurich,CH), A Mathe (Saint-Pierre,RE)

Authors:
S Paolillo1 , C Minoia2 , K Ablasser3 , G Di Stolfo4 , M Merlo5 , A Vachulova6 , F Ruschitzka7 , A Mathe8 , 1Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University of Naples - Naples - Italy , 2Sant' Antonio Abate Hospital , Cardiology - Gallarate - Italy , 3Medical University of Graz, Department of Cardiology - Graz - Austria , 4Casa Sollievo della Sofferenza Hospital, Cardiovascular Department - San Giovanni Rotondo - Italy , 5University of Trieste, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata - Trieste - Italy , 6The National Institute of Cardiovascular Diseases - Bratislava - Slovak Republic , 7University Heart Center, Department of Cardiology - Zurich - Switzerland , 8University Hospital of South Réunion, Department of Cardiology - Saint-Pierre - Reunion ,

On behalf: 1st Postgraduate Course in Heart Failure of the Heart Failure Association

Citation:
European Journal of Heart Failure ( 2017 ) 19 ( Suppl. S1 ), 470

Introduction. Glucose metabolism abnormalities are common in heart failure with reduced ejection fraction (HFrEF), and adversely influence long-term prognosis. An increasing interest is focused on the recognition of overt diabetes mellitus (DM) and of insulin-resistance (IR) in HFrEF patients to improve therapeutic management and prognosis.

Purpose. Aim of the present report was to analyze the prevalence and characteristics of these conditions in HFrEF patients enrolled across Europe.

Methods. Six HF specialists of 3 European countries (1 from Austria, 1 from France, 2 from North Italy, and 2 from South Italy) were involved in patients’ enrollment. In particular, they enrolled consecutive HFrEF patients seen from November 2016 to January 2017 fulfilling the subsequent criteria: 1) age =18 years; 2) EF =40%; 3) stable clinical conditions; 4) HF diagnosis since at least 6 months; 5) no acute coronary syndrome in the previous 3 months. On the same day patients underwent venous blood sample collection to assess fasting glucose, fasting insulin and glycated hemoglobin. IR was assessed through the evaluation of HOMA-IR, calculated by the formula [fasting Glucose (mmol/L) × fasting Insulin (mIU/L)/22.5], and the presence of IR was defined as HOMA-IR value >2.5.

Results. Two hundred twenty-two HFrEF patients were included in the analysis (72.5% M, mean age 66.5±12.4 yrs, mean EF 30.9±6.7%). The etiology of HF was ischemic in 131 (59%) patients, an idiopathic dilated cardiomyopathy in 75 (33.8%) subjects, and in the remaining cases other causes were identified; 71% of patients were in NYHA class I-II and 29% in NYHA III. Eighty patients (36%) exhibited DM (93.7% type 2 DM, 6.3% type 1 DM) with no significant differences among countries (47 vs. 37 vs. 34% in Austria, France and Italy, respectively; p=ns). Mean fasting glycemia was 141±44 mg/dl, mean HbA1c 7.5±1.7% and mean fasting insulin 20±22 uUI/ml; 34% were on treatment with oral antidiabetics alone, 20% with oral antidiabetic plus insulin, 21% with insulin alone, and the remaining patients were on diet control. HF was of ischemic etiology in 76% of cases, and an adequate, however not optimal HF therapy was prescribed (59% ACE-i or ARBs, 74% beta-blockers, 40% MRAs, 12% LCZ-696). As regards to IR, among non-diabetics the prevalence of IR was 46% with mean HOMA index of 3.1±2.8, mean fasting glycemia of 95±23 mg/dl and mean fasting insulinemia of 12±10 uUI/ml. HF was of ischemic etiology in 55% of cases and HF treatment was not optimal also in this group (65% ACE-i or ARBs, 73% beta-blockers, 30% MRAs, 0% LCZ-696).

Conclusions. Diabetes mellitus and insulin resistance are common comorbidities of European HF patients with similar distribution across countries and still not optimal HF treatment. More efforts are required to prompt recognize glucose metabolism abnormalities in HF and to optimize HF management in these subgroups to improve patients’ quality of life and long-term prognosis.

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