Impact of new-onset diabetes mellitus on cardiac outcomes in the Valsartan Antihypertensive Long-Term Use Evaluation (VALUE) trial population

被引:95
作者
Aksnes, Tonje A. [1 ]
Kjeldsen, Sverre E.
Rostrup, Morten
Omvik, Per
Hua, Tsushung A.
Julius, Stevo
机构
[1] Univ Oslo, Ullevaal Hosp, Dept Cardiol, N-0407 Oslo, Norway
[2] Univ Oslo, Ullevaal Hosp, Dept Acute Med, N-0407 Oslo, Norway
[3] Haukeland Hosp, Inst Internal Med, N-5021 Bergen, Norway
[4] Haukeland Hosp, Dept Cardiol, N-5021 Bergen, Norway
[5] Novartis Pharmaceut, E Hanover, NJ USA
[6] Univ Michigan, Div Cardiovasc Med, Ann Arbor, MI 48109 USA
关键词
congestive heart failure; diabetes mellitus; hypertension; morbidity; myocardial infarction; stroke;
D O I
10.1161/HYPERTENSIONAHA.106.085654
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
There has been a lot of interest about new-onset diabetes mellitus in recent hypertension trials, but the implications of diabetes development on cardiac outcomes have not been known. In the Valsartan Antihypertensive Long-Term Use Evaluation trial, 15 245 high-risk patients were followed for an average of 4.2 years. At baseline, 5250 patients were diabetic by the 1999 World Health Organization criteria, and among the 9995 nondiabetic patients, 1298 patients developed diabetes during follow-up. We have investigated the influence of diabetes development on outcomes in the Valsartan Antihypertensive Long-Term Use Evaluation trial. The patients with diabetes at baseline and new-onset diabetes were compared with patients who did not develop diabetes by a Cox regression model with adjustment for prespecified covariates ( age, diabetes status, left ventricular hypertrophy, baseline coronary heart disease, and randomized study treatment). Patients with diabetes at baseline had the highest cardiac morbidity defined as myocardial infarction and heart failure with a hazard ratio of 2.20 (95% CI: 1.95 to 2.49). The patients with new-onset diabetes had significantly higher cardiac morbidity, especially more congestive heart failure, than those without diabetes, with a hazard ratio of 1.43 ( 95% CI: 1.16 to 1.77). This indicates that patients who develop diabetes during antihypertensive treatment have cardiac morbidity intermediate between diabetic subjects and those subjects who never had diabetes and that it is of importance to find these patients at risk of diabetes development and optimize lifestyle and medical treatment.
引用
收藏
页码:467 / 473
页数:7
相关论文
共 28 条
  • [1] Alberti KGMM, 1998, DIABETIC MED, V15, P539, DOI 10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO
  • [2] 2-S
  • [3] Diabetes and cardiovascular events in hypertensive patients
    Alderman, MH
    Cohen, H
    Madhavan, S
    [J]. HYPERTENSION, 1999, 33 (05) : 1130 - 1134
  • [4] *ALLHAT OFF COORD, 2002, JAMA-J AM MED ASSOC, V288, P2981, DOI DOI 10.1001/JAMA.288.23.2981
  • [5] [Anonymous], 1985, World Health Organ Tech Rep Ser, V727, P1
  • [6] BAZILAY JI, 2006, ARCH INTERN MED, V166, P2191
  • [7] Impact of incident diabetes and incident nonfatal cardiovascular disease on 18-year mortality - The Multiple Risk Factor Intervention Trial experience
    Eberly, LE
    Cohen, JD
    Prineas, R
    Yang, LF
    [J]. DIABETES CARE, 2003, 26 (03) : 848 - 854
  • [8] Randomised trial of effects of calcium antagonists compared with diuretics and β-blockers on cardiovascular morbidity and mortality in hypertension:: the Nordic Diltiazem (NORDIL) study
    Hansson, L
    Hedner, T
    Lund-Johansen, P
    Kjeldsen, SE
    Lindholm, LH
    Syvertsen, JO
    Lanke, J
    de Faire, U
    Dahlöf, B
    Karlberg, BE
    [J]. LANCET, 2000, 356 (9227) : 359 - 365
  • [9] Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension:: the Captopril Prevention Project (CAPPP) randomised trial
    Hansson, L
    Lindholm, LH
    Niskanen, L
    Lanke, J
    Hedner, T
    Niklason, A
    Luomanmäki, K
    Dahlöf, B
    de Faire, U
    Mörlin, C
    Karlberg, BE
    Wester, PO
    Björck, JE
    [J]. LANCET, 1999, 353 (9153) : 611 - 616
  • [10] Elevated risk of cardiovascular disease prior to clinical diagnosis of type 2 diabetes
    Hu, FB
    Stampfer, MJ
    Haffner, SM
    Solomon, CG
    Willett, WC
    Manson, JE
    [J]. DIABETES CARE, 2002, 25 (07) : 1129 - 1134