Wednesday, November 23, 2011

Glycemic control and congestive heart failure

Lancet 2011; 378 140-146 Glycemic control and the incidence of heart failure
This is an interesting article that brings up another preventable complication of diabetes, congestive heart failure.
Congestive heart failure is basically a failure of a persons heart to pump an adequate volume of blood due to heart muscular damage. The symptoms are generally shortness of breath , swelling of a persons feet and legs and waking up short of breath at night and having to set up in order to breath comfortable. I have treated many patients with congestive heart failure over the years and have generally associated this problem with older age groups . This article followed 20895 patients with type one diabetes , mean age 38.5 years old , and found that 3 % ( 635 patients ) were admitted to the hospital with a primary or secondary diagnosis of heart failure over 9 years.

"Risk of heart

failure increased with age and duration of diabetes. Other modifiable factors associated with increased risk of heart failure were smoking, high systolic blood pressure, and raised body-mass index. In a subgroup of 18281 patients (87%) with data for blood lipids, higher HDL cholesterol was associated with lower risk of heart failure, but there was no association with LDL cholesterol. "

The above picture of a graph does not show well . It genererally shows that higher A1c results are associated with increased risk.

The only risk factors that are not within our power to control is our age and the duration of our diabetes. The others boil down to our own personal choice .

Diabetes is a game of numbers, play hard and win the day .

Dr. Calder

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Your comments and questions are appreciated. David Calder,MD