Visit-to-Visit Variability in Fasting Blood Glucose Predicts the New-Onset Heart Failure: Results From Two Large Chinese Cohorts

Previous studies have hypothesized an association between higher fasting blood glucose (FBG) and heart failure (HF). However, FBG values fluctuate continuously over time, the association between FBG variability and the risk of HF is uncertain. We investigated the relationship between visit-to-visit variability in FBG and the risk of new-onset HF. This cohort study used data from a prospective Kailuan cohort (recruited during 2006-2007) and a retrospective cohort of family medicine patients from Hong Kong (recruited during 2000-2003) were followed up until December 31st, 2016, and December 31st, 2019, respectively, for the outcome of incident HF. Four indexes of variability were used, including standard deviation (SD), coefficient of variation (CV), variability independent of the mean (VIM), and average real variability (ARV). Cox regression was used to identify HF. In total, 98,554 and 22,217 subjects without preexisting HF from the Kailuan and Hong Kong cohorts were analyzed, respectively, with 1218 cases of incident HF in the former and 4,041 in the latter. Subjects in the highest quartile of FBG-CV had the highest risk of incident HF in both cohorts (Kailuan: HR 1.245, 95% CI 1.055-1.470); Hong Kong: HR 1.362, 95%CI 1.145-1.620; compared with the lowest quartile). Similar results were observed when using FBG-ARV, FBG-VIM, and FBG-SD. Meta-analysis showed similar results (highest versus lowest quartile: HR 1.30, 95%CI 1.15-1.47, P < 0.0001). As observed from 2 large, geographically distinct Chinese cohorts, a higher FBG variability was independently associated with higher risk of incident HF.