OBJECTIVE -Diabetes is an independent risk factor for heart failure, whereas the relation between heart failure and abnormal glucose regulation (AGR) needs further evaluation. We studied this combination in the Reykjavík Study. RESEARCH DESIGN AND METHODS -The ReykjavíkStudy, a population-based cohort study during 1967-1997, recruited 19,381 participants aged 33-84 years who were followed until 2002. Oral glucose tolerance tests and chest X-rays were obtained from all participants. Cases were defined in accordance with World Health Organization criteria for type 2 diabetes or AGR (impaired glucose tolerance or impaired fasting glucose) and European Society of Cardiology guidelines for heart failure.RESULTS -The overall prevalence of type 2 diabetes and heart failure was 0.5% in men and 0.4% in women, while AGR and heart failure were found in 0.7% of men and 0.6% of women. Among participants with normal glucose regulation, heart failure was diagnosed in 3.2% compared with 6.0 and 11.8% among those with AGR and type 2 diabetes, respectively. The prevalence of type 2 diabetes in the age-group 45-65 years increased in both sexes during the period (P for trend ϭ 0.007). The odds ratio was 2.8 (95% CI 2.2-3.6) for the association between type 2 diabetes and heart failure and 1.7 (1.4 -2.1) between AGR and heart failure.CONCLUSIONS -There is a strong association between any form of glucometabolic perturbation and heart failure. Future studies in this field should focus on all types of glucose abnormalities rather than previously diagnosed diabetes only. Diabetes Care 28:612-616, 2005T ype 2 diabetes, a disease of increasing prevalence, is a risk factor for heart failure (1,2). Poor glucometabolic control, as reflected by a high HbA 1c , increases the risk of developing heart failure (3). Diabetic patients are more prone to develop heart failure during an ischemic event, despite comparable size of myocardial injury, and their prognosis is more unfavorable than that in nondiabetic patients (4).The prevalence of heart failure combined with diabetes was 10 and 15%, respectively, among elderly Italians. Moreover, a higher proportion of patients with than without heart failure developed diabetes over time (5). Although there are reports on the relationship of either diabetes or impaired glucose tolerance and heart failure (6,7), the association of the total spectrum of glucose abnormalities and heart failure, as well as the prevalence and risk factors for heart failure, has, to our knowledge, not been studied in a large epidemiological study.The Reykjavík Study is a populationbased study that included glucose tolerance tests for almost every participant. The present study reports on the prevalence of glucose abnormalities and heart failure and their combination in this population. RESEARCH DESIGN AND METHODS -All inhabitants in theReykjavík metropolitan area at 1 December 1966 and born 1907-1935 were invited to participate in the study, as previously reported (8). Those who participated (n ϭ 19,381) were divided into groups ...

In a randomly selected population of 9067 individuals, 32-64 years of age in 1967-1970, 25 (0.28%) had chronic atrial fibrillation (CAF). Eight had lone atrial fibrillation. In 1984 the cases were compared with an age- and sex-matched control group of 50 and found to have more cerebrovascular accidents (6 versus 2; P less than 0.05), congestive heart failure (9 versus 1; P less than 0.001), and valvular rheumatic heart disease (3 versus 0) or history consistent with rheumatic fever (6 versus 0; P less than 0.01). The mortality in the CAF group was 60% higher due to an excess in cardiovascular (relative risk 6.1; P less than 0.05) and cerebrovascular (relative risk 12.2; P less than 0.05) causes. The prevalence or incidence of ischaemic or hypertensive heart disease or the presence of coronary risk factors did not significantly differ in the two groups. By M-mode echocardiography the left atrial size, left ventricular enddiastolic dimension and left ventricular mass were increased in the CAF patients, while the systolic left ventricular shortening was significantly less. Thus, the prevalence of CAF is low in a randomly selected population 32-64 years of age and CAF is not strongly associated with ischaemic heart disease or hypertension. The CAF patients have an increased risk of dying prematurely particularly from cerebrovascular causes, even in the absence of valve disease.

Abstract-We performed a genomewide scan with 904 microsatellite markers using 120 extended Icelandic families with 490 hypertensive patients. The families were identified by cross-matching a list of hypertensive patients from the Hypertension Clinic of the University Hospital (Landspitalinn) in Iceland with a genealogy database of the entire Icelandic nation. After adding 5 markers, we found linkage to chromosome 18q with an allele-sharing LOD score of 4.60 (Pϭ2.1ϫ10 Ϫ6). These results provide evidence for a novel susceptibility gene for essential hypertension on chromosome 18q and show that it is possible to study the genetics of essential hypertension without stratifying by subphenotypes.

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