Hemoglobin A1c predicts heart failure hospitalization independent of baseline cardiac function or B-type natriuretic peptide level

Aims: Diabetes is a major risk factor for heart failure (HF). We examined whether baseline HbA_1c level predicts HF incidence independent of other HF risk factors, including baseline cardiac structural and functional abnormalities. Methods: In patients with type 2 diabetes, multivariable Cox regression models were constructed to examine the independent association between baseline HbA_1c and future HF hospitalization. Results: In 608 subjects (mean age, 66.5 years; men, 68%; mean HbA_1c, 9.1% (76mmol/mol)), 92 were hospitalized for HF during a median follow-up of 6 years. For a 1% (11mmol/mol) increase in baseline HbA_1c, the hazard ratio for HF was 1.23 (95% confidence interval, 1.1-1.7, p<0.001) with adjustment for age, sex, body mass index, blood pressure and plasma B-type natriuretic peptide (BNP) level. The effect of HbA_1c on HF was independent of baseline left ventricular (LV) ejection fraction, the ratio of peak early to late diastolic filling velocity, and prevalent/incident coronary heart disease (CHD), and was more evident in patients with enlarged LV, decreased systolic function, prevalent CHD, or prevalent HF. Conclusion: In patients with type 2 diabetes, HbA_1c significantly predicts future HF hospitalization independent of baseline BNP level or echocardiographic parameters.