April 11, 2012

Higher glucose benefits heart failure patients


In what world does a headline like this one see the light of day? In the world of UCLA researche it does.

Evidently, higher glucose levels in  advanced heart failure patients with diabetes may help improve  survival rates. No need to challenge the details. It’s all based on evidence gathered from patients with all the prerequisites: diabetes, heart failure, and 2 years data.

The study compared hemoglobin A1c (HbA1c)  in advanced heart failure patients with and without diabetes. Based on mortality outcomes the patients were analyzed insofar as their HbA1c levels. Researchers found that for heart failure patients with diabetes, for every unit increase in HbA1c there was a 15% decrease in mortality.

“We were surprised that the optimal level of [hemoglobin A1c] in this patient population with diabetes was higher than levels in current treatment guidelines,” said senior author Dr. Tamara Horwich, assistant professor of cardiology, David Geffen School of Medicine at UCLA. “We may find that doctors who treat patients who have both advanced heart failure and diabetes may not need to focus on aggressively lowering blood sugar, but rather keep it under moderate control.”

The paradoxical finding of this study is that higher, not lower HbA1c levels had better outcomes. The potential catastrophic outcomes were risk of death or need for an urgent heart. transplant.

How good were the outcomes? Researchers found that for diabetic heart failure patients, two-year event-free survival was highest amongst patients with the highest HbA1c. A 65% survival rate for patients with a HbA1c of greater than 8.6,  and 61% survival rate for patients with a HbA1c of 7.3 to 8.5.

Patients with lower HbA1c levels had worse survival rates: 48%survival rate for patients with a HbA1c of less than 6.4 and 42% survival rate with patients with a HbA1c of 6.5 to 7.2 .

The current national treatment targets aim is more aggressive at a HbA1c level of 7. The study supports that the ideal range for improved survival rate of patients  with advanced heart failure and diabetes is an HbA1c between 8.3 to 8.9.

The study shows that if a patient already has heart failure, having higher HbA1c level may be protective. It does not condone people with diabetes and a perfectly healthy heart to run higher HbA1c levels. Having diabetes and an elevated HbA1c  is a risk factor for developing heart conditions.

It’s not every day that you read information of this sort in diabetes. Then again, it’s not every day that you learn your heart is failing. Approximately 25 to 50%of patients with heart failure also have diabetes. Try not to be that guy or girl. Keep your glucose levels in-check and your heart will keep up with the beat.  

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