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Randomized Controlled Trial
. 2019 Dec;6(6):1252-1261.
doi: 10.1002/ehf2.12516. Epub 2019 Oct 24.

Impaired glucose tolerance and albuminuria in patients with chronic heart failure: a subanalysis of the SUPPORT trial

Kotaro Nochioka  1 , Yasuhiko Sakata  1 , Masanobu Miura  1 , Takashi Shiroto  1 , Jun Takahashi  1 , Chie Saga  2 , Yasuko Ikeno  2 , Nobuyuki Shiba  3 , Tsuyoshi Shinozaki  4 , Masafumi Sugi  5 , Makoto Nakagawa  6 , Tatsuya Komaru  7 , Atsushi Kato  8 , Eiji Nozaki  9 , Kaoru Iwabuchi  10 , Tetsuya Hiramoto  11 , Kanichi Inoue  12 , Masatoshi Ohe  13 , Kenji Tamaki  14 , Ichiro Tsuji  15 , Hiroaki Shimokawa  1   2
Affiliations
Randomized Controlled Trial

Impaired glucose tolerance and albuminuria in patients with chronic heart failure: a subanalysis of the SUPPORT trial

Kotaro Nochioka et al. ESC Heart Fail. 2019 Dec.

Abstract

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.

Keywords: Albuminuria; Chronic heart failure; Diabetes mellitus; Impaired glucose tolerance.

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Conflict of interest statement

The Department of Evidence‐based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, is supported in part by the unrestricted research grants from Daiichi Sankyo Co., Ltd. (Tokyo, Japan), Bayer Yakuhin, Ltd. (Osaka, Japan), Kyowa Hakko Kirin Co., Ltd. (Tokyo, Japan), Kowa Pharmaceutical Co., Ltd. (Tokyo, Japan), Novartis Pharma K.K. (Tokyo, Japan), Dainippon Sumitomo Pharma, Co., Ltd. (Osaka, Japan), and Nippon Boehringer Ingelheim Co., Ltd. (Tokyo, Japan). H.S. has received lecture fees from Bayer Yakuhin, Ltd. (Osaka, Japan), Daiichi Sankyo Co., Ltd. (Tokyo, Japan), and Novartis Pharma K.K. (Tokyo, Japan).

Figures

Figure 1
Figure 1
Study diagram. DM, diabetes mellitus; HbA1c, haemoglobin A1c; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; NGR, normal glucose regulation; OGTT, oral glucose tolerance test.
Figure 2
Figure 2
Event rates (per 1000 person‐years) for the composite of all‐cause death, non‐fatal myocardial infraction (MI), non‐fatal stroke, and hospitalization for worsening HF. Event rates were analysed with the exact probability test.
See this image and copyright information in PMC

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