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Predictors of incident heart failure hospitalizations among patients with impaired glucose tolerance: insight from the Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research study.

Publication ,  Journal Article
Wong, YW; Thomas, L; Sun, J-L; McMurray, JJV; Krum, H; Hernandez, AF; Rutten, GEHM; Leiter, LA; Standl, E; Haffner, SM; Mazzone, T; Tognoni, G ...
Published in: Circ Heart Fail
March 2013

BACKGROUND: Impaired glucose tolerance and metabolic syndrome are associated with increased risk of heart failure (HF). However, predictors associated with the increased risk of incident HF have not been well characterized. We aimed to identify independent predictors of incident HF hospitalization among patients with impaired glucose tolerance. METHODS AND RESULTS: In Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR), 9306 research participants with impaired glucose tolerance and ≥1 cardiovascular risk factors were randomized to valsartan versus placebo and nateglinide versus placebo in a 2×2 factorial manner, with a median follow-up of 6.5 years. Using a multivariable Cox proportional hazards model, we analyzed the relationships among baseline clinical factors and the outcome of incident HF hospitalization in patients without history of HF. Significant predictors were identified by forward selection. Increasing age, history of coronary heart disease, and atrial fibrillation or flutter were among several known independent predictors of incident HF hospitalization. Increased waist circumference (hazard ratio per 10 cm, 1.37; 95% confidence interval, 1.21-1.55; P<0.001) and increased urinary albumin-creatinine ratio (P<0.001) were identified as novel predictors. The predictive model for incident HF hospitalization showed good discrimination, with an optimism-corrected C-index of 0.79. CONCLUSIONS: Among research participants with impaired glucose tolerance, there are several easily identifiable predictors of incident HF hospitalization, including traditional risk factors and novel indices of central adiposity and increased urinary albumin-creatinine ratio, which enable further risk stratification and help distinguish patients who could benefit from more aggressive risk factor management.

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Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

March 2013

Volume

6

Issue

2

Start / End Page

203 / 210

Location

United States

Related Subject Headings

  • Waist Circumference
  • Valsartan
  • Valine
  • Treatment Outcome
  • Time Factors
  • Tetrazoles
  • Risk Factors
  • Risk Assessment
  • Prospective Studies
  • Proportional Hazards Models
 

Citation

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Wong, Y. W., Thomas, L., Sun, J.-L., McMurray, J. J. V., Krum, H., Hernandez, A. F., … Califf, R. M. (2013). Predictors of incident heart failure hospitalizations among patients with impaired glucose tolerance: insight from the Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research study. Circ Heart Fail, 6(2), 203–210. https://doi.org/10.1161/CIRCHEARTFAILURE.112.000086
Wong, Yee Weng, Laine Thomas, Jie-Lena Sun, John J. V. McMurray, Henry Krum, Adrian F. Hernandez, Guy E. H. M. Rutten, et al. “Predictors of incident heart failure hospitalizations among patients with impaired glucose tolerance: insight from the Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research study.Circ Heart Fail 6, no. 2 (March 2013): 203–10. https://doi.org/10.1161/CIRCHEARTFAILURE.112.000086.
Wong, Yee Weng, et al. “Predictors of incident heart failure hospitalizations among patients with impaired glucose tolerance: insight from the Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research study.Circ Heart Fail, vol. 6, no. 2, Mar. 2013, pp. 203–10. Pubmed, doi:10.1161/CIRCHEARTFAILURE.112.000086.
Wong YW, Thomas L, Sun J-L, McMurray JJV, Krum H, Hernandez AF, Rutten GEHM, Leiter LA, Standl E, Haffner SM, Mazzone T, Martinez FA, Tognoni G, Giles T, Califf RM. Predictors of incident heart failure hospitalizations among patients with impaired glucose tolerance: insight from the Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research study. Circ Heart Fail. 2013 Mar;6(2):203–210.

Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

March 2013

Volume

6

Issue

2

Start / End Page

203 / 210

Location

United States

Related Subject Headings

  • Waist Circumference
  • Valsartan
  • Valine
  • Treatment Outcome
  • Time Factors
  • Tetrazoles
  • Risk Factors
  • Risk Assessment
  • Prospective Studies
  • Proportional Hazards Models