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Echeverría LE, Saldarriaga C, Campbell-Quintero S, Morales-Rodríguez LN, López-Ponce de León JD, Buitrago AF, Martínez-Carreño E, Sandoval-Luna JA, Llamas A, Moreno-Silgado GA, Vanegas-Eljach J, Murillo-Benítez NE, Gómez-Paláu R, Rivera-Toquica AA, Gómez-Mesa JE. Diabetes mellitus in patients with heart failure and effect modification of risk factors for short-term mortality: An observational study from the Registro Colombiano de Falla Cardíaca (RECOLFACA). BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2024; 44:182-197. [PMID: 39079149 PMCID: PMC11368228 DOI: 10.7705/biomedica.6951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/15/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION Heart failure and type 2 diabetes mellitus are critical public health issues. OBJECTIVE To characterize the risk factors for mortality in patients with heart failure and type 2 diabetes mellitus from a large registry in Colombia and to evaluate the potential effect modifications by type 2 diabetes mellitus over other risk factors. MATERIALS AND METHODS Heart failure patients with and without type 2 diabetes mellitus enrolled in the Registro Colombiano de Falla Cardíaca (RECOLFACA) were included. RECOLFACA enrolled adult patients with heart failure diagnosis from 60 medical centers in Colombia during 2017-2019. The primary outcome was all-cause mortality. Survival analysis was performed using adjusted Cox proportional hazard models. RESULTS A total of 2514 patients were included, and the prevalence of type 2 diabetes mellitus was 24.7% (n = 620). We found seven independent predictors of short-term mortality for the general cohort, chronic obstructive pulmonary disease, sinus rhythm, triple therapy, nitrates use, statins use, anemia, and hyperkalemia. In the type 2 diabetes mellitus group, only the left ventricle diastolic diameter was an independent mortality predictor (HR = 0.96; 95% CI: 0.93-0.98). There was no evidence of effect modification by type 2 diabetes mellitus on the relationship between any independent predictors and all-cause mortality. However, a significant effect modification by type 2 diabetes mellitus between smoking and mortality was observed. CONCLUSIONS Patients with type 2 diabetes mellitus had higher mortality risk. Our results also suggest that type 2 diabetes mellitus diagnosis does not modify the effect of the independent risk factors for mortality in heart failure evaluated. However, type 2 diabetes mellitus significantly modify the risk relation between mortality and smoking in patients with heart failure.
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Affiliation(s)
- Luis Eduardo Echeverría
- Departamento de Cardiología, Fundación Cardiovascular de Colombia, Bucaramanga, ColombiaFundación Cardiovascular de ColombiaDepartamento de CardiologíaFundación Cardiovascular de ColombiaBucaramangaColombia
| | - Clara Saldarriaga
- Departamento de Cardiología, Clínica Cardio VID, Medellín, ColombiaClínica Cardio VIDDepartamento de CardiologíaClínica Cardio VIDMedellínColombia
| | - Sebastián Campbell-Quintero
- Departamento de Cardiología, Clínica Medilaser, Florencia, ColombiaClínica MedilaserDepartamento de CardiologíaClínica MedilaserFlorenciaColombia
| | - Lisbeth Natalia Morales-Rodríguez
- Departamento de Cardiología, Clínica Medilaser, Neiva, ColombiaClínica MedilaserDepartamento de CardiologíaClínica MedilaserNeivaColombia
| | - Juan David López-Ponce de León
- Departamento de Cardiología, Fundación Valle de Lili, Cali, ColombiaFundación Valle de LiliDepartamento de CardiologíaFundación Valle de LiliCaliColombia
| | - Andrés Felipe Buitrago
- Departamento de Cardiología, Fundación Santa Fe de Bogotá, Bogotá, D.C., ColombiaFundación Santa Fe de BogotáDepartamento de CardiologíaFundación Santa Fe de BogotáBogotá, D.C.Colombia
| | - Erika Martínez-Carreño
- Departamento de Cardiología, Institución Clínica Iberoamérica Sanitas, Barranquilla, ColombiaInstitución Clínica Iberoamérica SanitasDepartamento de CardiologíaInstitución Clínica Iberoamérica SanitasBarranquillaColombia
| | - Jorge Alberto Sandoval-Luna
- Departamento de Cardiología, Cardiología Siglo XXI, Ibagué, ColombiaCardiología Siglo XXIDepartamento de CardiologíaCardiología Siglo XXIIbaguéColombia
| | - Alexis Llamas
- Departamento de Cardiología, Clínica Las Américas, Medellín, ColombiaClínica Las AméricasDepartamento de CardiologíaClínica Las AméricasMedellínColombia
| | - Gustavo Adolfo Moreno-Silgado
- Departamento de Cardiología, Hospicardio, Montería, ColombiaHospicardioDepartamento de CardiologíaHospicardioMonteríaColombia
| | - Julián Vanegas-Eljach
- Departamento de Cardiología, Hospital Alma Máter, Antioquia, ColombiaHospital Alma MáterDepartamento de CardiologíaHospital Alma MáterAntioquiaColombia
| | - Nelson Eduardo Murillo-Benítez
- Departamento de Cardiología, Angiografía de Occidente, Cali, ColombiaAngiografía de OccidenteDepartamento de CardiologíaAngiografía de OccidenteCaliColombia
| | - Ricardo Gómez-Paláu
- Departamento de Cardiología, Clínica Imbanaco-Grupo Quirón Salud, Cali, ColombiaClínica Imbanaco-Grupo Quirón SaludDepartamento de CardiologíaClínica Imbanaco-Grupo Quirón SaludCaliColombia
| | - Alex Arnulfo Rivera-Toquica
- Departamento de Cardiología, Centro Médico para el Corazón, Pereira, ColombiaCentro Médico para el CorazónDepartamento de CardiologíaCentro Médico para el CorazónPereiraColombia
| | - Juan Esteban Gómez-Mesa
- Departamento de Cardiología, Fundación Valle de Lili, Cali, ColombiaFundación Valle de LiliDepartamento de CardiologíaFundación Valle de LiliCaliColombia
- Departamento de Ciencias de la Salud, Universidad Icesi, Cali, ColombiaUniversidad IcesiDepartamento de Ciencias de la SaludUniversidad IcesiCaliColombia
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Selvarajah S, Uiterwaal CSPM, Haniff J, van der Graaf Y, Visseren FLJ, Bots ML. Renal impairment and all-cause mortality in cardiovascular disease: effect modification by type 2 diabetes mellitus. Eur J Clin Invest 2013; 43:198-207. [PMID: 23301500 DOI: 10.1111/eci.12035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 11/22/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Renal impairment and type 2 diabetes mellitus (DM) are well-known independent risk factors for mortality. The evidence of their combined effects on mortality is unclear, but of importance because it may determine aggressiveness of treatment. This study sought to assess and quantify the effect modification of diabetes on renal impairment in its association with mortality. MATERIALS AND METHODS Patients with cardiovascular disease or at high risk, recruited in the Second Manifestations of ARTerial disease cohort study, were selected. A total of 7135 patients were enrolled with 33 198 person-years of follow-up. Renal impairment was defined by albuminuria status and estimated glomerular filtration rate (eGFR). Outcome was all-cause mortality. RESULTS Mortality increased progressively with each stage of renal impairment, for both albuminuria status and eGFR, for diabetics and non-diabetics. There was no effect modification by diabetes on mortality risk due to renal impairment. The relative excess risk due to interaction (RERI) for DM and microalbuminuria was 0·21 (-0·11, 0·52), for overt proteinuria -1·12 (-2·83, 0·59) and for end-stage renal failure (ESRF) 0·32 (-3·65, 4·29). The RERI for DM with eGFR of 60-89 mL/min/1·73 m(2) was -0·31(-0·92, 0·32), for eGFR of 30-59 mL/min/1·73 m(2) -0·07 (-0·76, 0·62) and for eGFR of < 30 mL/min/1·73 m(2) 0·38 (-0·85, 1·61). CONCLUSIONS Type 2 diabetes mellitus does not modify nor increase the risk relation between all-cause mortality and renal impairment. These findings suggest that the hallmark for survival is the prevention and delay in progression of renal impairment in patients with cardiovascular disease.
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Affiliation(s)
- Sharmini Selvarajah
- Clinical Research Centre, Ministry of Health Malaysia, Kuala Lumpur 50586, Malaysia.
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Farkouh ME, Mathew V. The PROSPECT of Changing Our Approach to Acute Coronary Syndromes⁎⁎Editorials published in JACC: Cardiovascular Imaging reflect the views of the authors and do not necessarily represent the views of JACC: Cardiovascular Imaging or the American College of Cardiology. JACC Cardiovasc Imaging 2012; 5:S73-5. [DOI: 10.1016/j.jcmg.2012.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 02/02/2012] [Indexed: 10/28/2022]
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Farkouh ME, Aneja A, Reeder GS, Smars PA, Lennon RJ, Wiste HJ, Traverse K, Razzouk L, Basu A, Holmes DR, Mathew V. Usefulness of diabetes mellitus to predict long-term outcomes in patients with unstable angina pectoris. Am J Cardiol 2009; 104:492-7. [PMID: 19660600 DOI: 10.1016/j.amjcard.2009.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 04/02/2009] [Accepted: 04/02/2009] [Indexed: 10/20/2022]
Abstract
The objective of this study was to determine short- and long-term cardiovascular outcomes in unselected patients with diabetes mellitus (DM) with acute ischemic chest pain (AICP). In patients with DM presenting to the emergency department with AICP, short-term cardiovascular outcomes remain discordant between trials and registries, whereas long-term outcomes are not well-described. A consecutive cohort of all residents of Olmsted County, Minnesota, presenting with AICP from January 1, 1985, to December 31, 1992, was followed for a median duration of 16.6 years. The primary outcome was long-term all-cause mortality. Other outcomes included a composite of death, myocardial infarction, stroke, and revascularization (major adverse cardiovascular and cerebrovascular events [MACCEs]) as well as heart failure (HF) events at 30 days and at a median of 7.3 years, respectively. Of the 2,271 eligible patients, 336 (14.8%) were classified with DM. The crude 30-day MACCE rate was 10.1% in patients with DM and 6.1% in those without DM (p = 0.007). HF events were more common in patients with DM at 30 days (9.8% vs 3.1%, p <0.001). At 7.3 years, patients with DM were more likely to experience MACCEs and HF events than those without DM (71.2% vs 45.1%, unadjusted hazard ratio 2.15%, 95% confidence interval 1.87 to 2.48, p <0.001, and 45.1% vs 18.2%, p <0.001, respectively). Over the follow-up period, 272 patients with DM (81.9%) died, compared with 936 (49.2%) without DM (p <0.001). In conclusion, DM is associated with a higher short-term risk for MACCEs and HF and a higher long-term risk for mortality in unselected patients with AICP. DM should be included as a high-risk variable in national acute coronary syndrome guidelines.
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