Albuminuria as a predictor of heart failure hospitalizations in patients with type 2 diabetes

Background: Heart failure (HF) occurs more frequently and is a significant cause of mortality in diabetic patients. The purpose of the current study is to ascertain risk factors that are predictive of HF hospitalizations in type 2 diabetic patients. Methods: Longitudinal observational study of type 2 diabetic patients with baseline diastolic blood pressures greater than or equal to80 mm Hg and no history of New York Heart Association class III-IV HF or a serum creatinine greater than or equal to2.5 mg/dL nested within a randomized clinical trial. The outcome measure of this study was the first occurrence of HF hospitalization over a 5-year follow-up period. Results: Patients with overt albuminuria at baseline had a higher and earlier occurrence of HF hospitalizations than those with micro- or normoalbuminuria (13.6% versus 3.3%, odds ratio [OR] = 3.1, 95% confidence interval [CI] = 2.15-4.60, P < .0001). In the multiple logistic regression analyses, the presence of overt albuminuria (OR 5.4, 95% CI = 2.3-12.5, P < .001), history of myocardial infarction (OR 4.6, 95% CI = 1.6-13.1, P = .004) and a history of New York Heart Association Class I or II HF (OR 8.0, 95% CI = 2.2-28.6, P = .0014) at baseline were independently associated with HF hospitalizations. Conclusions: Overt albuminuria predicts the occurrence of HF hospitalizations in type 2 diabetic patients. Thus early aggressive treatment of diabetic nephropathy should be investigated as a means of preventing of HF.