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Long-Term Impact of Diabetes Mellitus on Survival in Idiopathic and Heritable Pulmonary Arterial Hypertension
October 2012, Vol 142, No. 4_MeetingAbstracts Pulmonary Vascular Disease | October 2012
Long-Term Impact of Diabetes Mellitus on Survival in Idiopathic and Heritable Pulmonary Arterial Hypertension Levi Benson*, MD; Meredith Pugh, MD; Eric Austin, MD; Kelly Fox, RN; Lisa Wheeler, BA; Evan Brittain, MD; Ivan Robbins, MD; Anna Hemnes, MD Vanderbilt University, Nashville, TN
Chest. 2012;142(4_MeetingAbstracts):847A. doi:10.1378/chest.1390335
Abstract SESSION TYPE: DVT/PE/Pulmonary Hypertension Posters II PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM PURPOSE: Pulmonary arterial hypertension (PAH) is a rare disease with high morbidity and mortality. There are multiple associated conditions, each with unique risk factors for development of the disease. Previous studies have suggested that insulin resistance is highly prevalent in patients with PAH; the long-term impact of this finding on survival in PAH is unclear. We aimed to investigate differences in mortality between PAH patients with and without diabetes. METHODS: From a prospective registry of PAH patients seen at our institution, we analyzed the effect of diabetes mellitus (DM) on survival. DM was defined as any of the following: hemoglobin A1c of 6.0% or greater, patients who had a random non-fasting glucose value of greater than 200mg/dL, or patients who were treated with an FDA-approved medication for DM. Patients who met none of these criteria were defined as non-diabetic (NDM). PAH was diagnosed according to standard criteria and only patients with idiopathic (IPAH) or hereditary (HPAH) PAH and right heart catheterization (RHC) data were included in this analysis. RESULTS: A total of 113 patients were analyzed: 29 with DM and 84 NDM. Baseline characteristics were similar between diabetic and non-diabetic PAH patients. Gender, age at diagnosis of PAH, PAH type and duration, and 6 minute walk distance were similar between groups. BMI was similar in the two groups
(31.4 ± 6.78 vs 29.8 ± 8.3 kg/m2, p=0.34), as was BNP (382 ± 630 vs 282 ± 434 pg/mL). RHC data did not differ significantly between the two groups. However, a significant survival difference at 10 years was found between the two groups (p=0.04 by log rank). CONCLUSIONS: Utilizing data from a large database of PAH patients, we show reduced survival in IPAH and HPAH patients with DM compared to those without. CLINICAL IMPLICATIONS: Further work should be directed at determining whether available antidiabetic medications may impact the course of PAH; work to elucidate a pathologic mechanism of this mortality difference would also be recommended. DISCLOSURE: The following authors have nothing to disclose: Levi Benson, Meredith Pugh, Eric Austin, Kelly Fox, Lisa Wheeler, Evan Brittain, Ivan Robbins, Anna Hemnes No Product/Research Disclosure Information Vanderbilt University, Nashville, TN
Long-Term Impact of Diabetes Mellitus on Survival in Idiopathic and Heritable Pulmonary Arterial Hypertension Levi Benson*, MD; Meredith Pugh, MD; Eric Austin, MD; Kelly Fox, RN; Lisa Wheeler, BA; Evan Brittain, MD; Ivan Robbins, MD; Anna Hemnes, MD Vanderbilt University, Nashville, TN
Chest. 2012;142(4_MeetingAbstracts):847A. doi:10.1378/chest.1390335
Abstract SESSION TYPE: DVT/PE/Pulmonary Hypertension Posters II PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM PURPOSE: Pulmonary arterial hypertension (PAH) is a rare disease with high morbidity and mortality. There are multiple associated conditions, each with unique risk factors for development of the disease. Previous studies have suggested that insulin resistance is highly prevalent in patients with PAH; the long-term impact of this finding on survival in PAH is unclear. We aimed to investigate differences in mortality between PAH patients with and without diabetes. METHODS: From a prospective registry of PAH patients seen at our institution, we analyzed the effect of diabetes mellitus (DM) on survival. DM was defined as any of the following: hemoglobin A1c of 6.0% or greater, patients who had a random non-fasting glucose value of greater than 200mg/dL, or patients who were treated with an FDA-approved medication for DM. Patients who met none of these criteria were defined as non-diabetic (NDM). PAH was diagnosed according to standard criteria and only patients with idiopathic (IPAH) or hereditary (HPAH) PAH and right heart catheterization (RHC) data were included in this analysis. RESULTS: A total of 113 patients were analyzed: 29 with DM and 84 NDM. Baseline characteristics were similar between diabetic and non-diabetic PAH patients. Gender, age at diagnosis of PAH, PAH type and duration, and 6 minute walk distance were similar between groups. BMI was similar in the two groups
(31.4 ± 6.78 vs 29.8 ± 8.3 kg/m2, p=0.34), as was BNP (382 ± 630 vs 282 ± 434 pg/mL). RHC data did not differ significantly between the two groups. However, a significant survival difference at 10 years was found between the two groups (p=0.04 by log rank). CONCLUSIONS: Utilizing data from a large database of PAH patients, we show reduced survival in IPAH and HPAH patients with DM compared to those without. CLINICAL IMPLICATIONS: Further work should be directed at determining whether available antidiabetic medications may impact the course of PAH; work to elucidate a pathologic mechanism of this mortality difference would also be recommended. DISCLOSURE: The following authors have nothing to disclose: Levi Benson, Meredith Pugh, Eric Austin, Kelly Fox, Lisa Wheeler, Evan Brittain, Ivan Robbins, Anna Hemnes No Product/Research Disclosure Information Vanderbilt University, Nashville, TN