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A propensity matched study of the effect of diabetes on the natural history of heart failure: variations by sex and age
  1. Ali Ahmed (aahmed{at}uab.edu)
  1. University of Alabama at Birmingham and VA Medical Center, Birmingham, Alabama, United States
    1. Inmaculada B Aban (caban{at}ms.soph.uab.edu)
    1. University of Alabama at Birmingham, Birmingham, AL, United States
      1. Viola Vaccarino (lvaccar{at}emory.edu)
      1. Department of Medicine, Division of Cardiology, Emory University School of Medic, United States
        1. Donald M Lloyd-Jones (dlj{at}northwestern.edu)
        1. Northwestern University, Chicago, IL, United States
          1. David C Goff, Jr (dgoff{at}wfubmc.edu)
          1. Wake Forest University, Winston-Salem, NC, United States
            1. Jiannan Zhao (jianzhao{at}uab.edu)
            1. University of Alabama at Birmingham, Birmingham, AL, United States
              1. Thomas E Love (thomas.love{at}case.edu)
              1. Case Western Reserve University, Cleveland OH, United States
                1. Christine Ritchie (critchie{at}aging.uab.edu)
                1. University of Alabama at Birmingham and VA Medical Center, Birmingham, AL, United States
                  1. Fernando Ovalle (fovalle{at}uabmc.edu)
                  1. University of Alabama at Birmingham and VA Medical Center, Birmingham, AL, United States
                    1. Giovanni Gambassi (giovanni_gambassi{at}rm.unicatt.it)
                    1. Università Cattolica del Sacro Cuore, Rome, Italy
                      1. Louis J Dell’Italia, (dell'italia{at}physiology.uab.edu)
                      1. University of Alabama at Birmingham and VA Medical Center, Birmingham, AL, United States

                        Abstract

                        Background: Poor prognosis in heart failure (HF) patients with diabetes is often attributed to increased comorbidity and advanced disease. Further, this effect may be worse in women.

                        Objective: To determine whether the effect of diabetes on outcomes and the sex-related variation persisted in a propensity score matched HF population, and whether the sex-related variation was a function of age.

                        Methods: Of the 7788 HF patients in the Digitalis Investigation Group trial, 2218 had a history of diabetes. Propensity score for diabetes was calculated for each patient using a non-parsimonious logistic regression model incorporating all measured baseline covariates, and was used to match 2056 (93%) diabetic patients with 2056 non-diabetic patients.

                        Results: All-cause mortality occurred in 135 (25%) and 216 (39%) women without and with diabetes (adjusted hazard ratio {AHR} =1.67; 95% confidence interval {CI} =1.34-2.08; p<0.0001). Among men, 535 (36%) and 609 (41%) patients without and with diabetes died from all causes (AHR =1.21; 95% CI =1.07-1.36; p=0.002). Sex-diabetes interaction (overall adjusted p <0.0001) was only significant in patients >65 years (15% absolute risk increase in women; multivariable p for interaction =0.005), but not in younger patients (2% increase in women; p for interaction =0.173). Risk-adjusted HR (95% CI) for all-cause hospitalization for women and men were respectively 1.49 (1.28-1.72) and 1.21 (1.11-1.32), also with significant sex-diabetes interaction (p=0.011).

                        Conclusions: Diabetes-associated increases in morbidity and mortality in chronic HF were more pronounced in women, and theses sex-related differences in outcomes were primarily observed in elderly patients.

                        • Age
                        • Diabetes
                        • Heart failure
                        • Outcomes
                        • Sex

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