Glucose, obesity, metabolic syndrome, and diabetes relevance to incidence of heart failure

Abstract

Heart failure (HF) is common, results in poor clinical outcomes, and is associated with large health care costs. The incidence of HF continues to rise, with approximately 670,000 new cases per year and a 20% lifetime risk of HF for persons 40 years and older in the U.S. Risk factors for HF have been identified, and thus preventative strategies should have a positive effect on disease burden, morbidity, and mortality. Although coronary artery disease and hypertension have traditionally been considered among the most important modifiable risk factors for the development of HF, recent studies have highlighted the importance of increasingly prevalent metabolic risk factors: glucose, diabetes, obesity, and the metabolic syndrome. This report will present evidence for the link between glucose, diabetes, obesity, metabolic syndrome, and incident HF. Furthermore, we will discuss how risk factor modification and other preventive therapies may help curb the rising incidence of HF.

Figure 1. Age-Adjusted Hospitalization Rates for Heart Failure

National Hospital Discharge Survey, 1979–2004Trends of age-adjusted heart failure hospitalization rate (per 100,000) from 1979 to 2004 among patients with heart failure as the first-listed or additional (2nd to 7th) diagnosis for men and women. From Fang, J., G. A. Mensah, et al. (2008). “Heart Failure-Related Hospitalization in the U.S., 1979 to 2004.” Journal of the American College of Cardiology 52(6): 428.

Figure 2

Multiple Pathogenetic Mechanisms Involved in the Relationship Between Diabetes, Metabolic Disease, and Heart Failure.

Figure 3. Cumulative Incidence of HF According to Categories of BMI

From Kenchaiah S, Sesso HD, Gaziano JM. Body Mass Index and Vigorous Physical Activity and the Risk of Heart Failure Among Men. Circulation 2009;119:44-52.

Figure 4. Recommended Therapies by Stage of Heart Failure Algorithm

ACEI indicates angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; EF, ejection fraction; FHx CM, family history of cardiomyopathy; HF, heart failure; LV, left ventricular; LVH, left ventricular hypertrophy; and MI, myocardial infarction. From American College of Cardiology Foundation/American Heart Association Task Force on Practice G, International Society for Heart and Lung T, Hunt SA, et al. 2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults. J Am Coll Cardiol 2009:j.jacc.2008.11.013.