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Older Women with Heart Disease, Diabetes have Triple the Risk of Heart Failure
Older Women with Heart Disease, Diabetes have Triple the Risk of Heart Failure -- Posted by Gumbo on 10-24-04 12:39
Older Women with Heart Disease, Diabetes have Triple the Risk of Heart
Failure
Postmenopausal women with heart disease have three times the risk of
developing heart failure if they also have diabetes, researchers report.
In addition, diabetic women in the study who also had kidney disease or
obesity, or whose diabetes was poorly controlled (fasting blood sugar levels
above 300 mg/dL) had a risk of heart failure 6-10 times higher than that of
women without diabetes.
Researchers analyzed records from 2391 participants in the Heart and
Estrogen/Progesterone Replacement Study (HERS) to determine risk factors for
developing heart failure. Previous studies recognized some significant
differences in heart failure between men and women. In men, for example, a
heart attack more often precedes heart failure.
The study was published in Circulation.
"In women, heart failure seems to happen often in the absence of a heart
attack," said Kirsten Bibbins-Domingo, MD, PhD, lead author and an
instructor in medicine, epidemiology and biostatistics at the University of
California, San Francisco. "Our goal was to find out what the risk factors
were in women."
In the study, 237 of the women (average age 68.3) developed heart failure
during an average of 6.3 years in HERS and its follow-up. The HERS trial
tested the effectiveness of hormones in preventing a second heart attack in
women who had already suffered one.
The study revealed nine health factors that identify postmenopausal women
with coronary artery disease who have an increased risk of developing
congestive heart failure. Diabetes was the most powerful predictor of heart
failure. Women who had the disease on entering HERS were 3.1 times more
likely to develop heart failure than women who did not. The risk from atrial
fibrillation (abnormal rapid beats in the heart's upper chambers) was nearly
as great. Women with this abnormal heart rhythm were 2.9 times more likely
to develop heart failure than women who did not have the condition.
The seven other factors are, in descending order of significance: two or
more previous heart attacks, insufficient kidney function, hypertension,
obesity, current smoking, and two heart disorders, left bundle branch block
(a block in electrical impulses through the heart) and left ventricular
hypertrophy.
"Lifestyle changes and/or medications can modify or prevent several of the
nine risk factors," Bibbins-Domingo said. "Physicians treating women with
coronary disease should also focus on the risk factors for heart failure
that are preventable or modifiable. These include controlling hypertension
particularly, and also controlling blood sugar and obesity."
Physicians long regarded heart failure as essentially a disease of men. "As
with many types of heart disease, we are learning that heart failure is an
equal-opportunity disease," Bibbins-Domingo said. "There is a new
realization among clinicians that heart failure, in particular, is also a
woman's disease."
Among other findings:
1) Women with diabetes who had well-controlled blood sugar levels had a
relatively low rate of heart failure.
2) The danger of developing heart failure increased in women with multiple
risk factors. For example, women with none of the nine risk factors had an
annual incidence of only 0.4%, while women with three or more risk factors
but no diabetes had a 3.4% annual incidence of heart failure. The yearly
incidence for diabetic women who had three additional risk factors rose to
8.2%.
3) For women who had diabetes and kidney disease, the annual incidence of
heart failure was 13%.
4) Estrogen/progestin use was not associated with developing heart failure.
5) A heart attack increased a woman's risk of heart failure to 1.4 times
that of women who had not had one. Women with two or more heart attacks had
a risk 2.5 times greater.
6) Women with systolic blood pressure readings greater than 140 mm Hg had a
2.1 times greater risk than those whose systolic pressure ranged from 80-120
mm Hg.
7)·Current smokers had 1.9 times the risk of heart failure, "but being a
former smoker does not put you at risk - one more reason to stop smoking,"
Bibbins-Domingo said.
8)·Women with a body mass index of more than 35 kg/m2 had a 1.9 times
greater risk than those with a BMI of less than 25 kg/m2 (Bibbins-Domingo K,
Lin F, Vittinghoff E, et al., Predictors of heart failure among women with
coronary disease. Circulation, 2004;110(11):1424-30). This article was
prepared by Biotech Week editors from staff and other reports.
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