Higher Long-term Visit-to-Visit Variability in Fasting Plasma Glucose Predicts New-Onset Heart Failure in the General Population

Background: Previous studies suggested an adverse association between higher fasting blood glucose (FBG) and heart failure. However, FBG values fluctuate continuously over time, the association between FBG variability and the risk of heart failure is uncertain.Aims: We investigated the relationship between visit-to-visit variability in FBG and the risk of new-onset heart failure.Methods and Results: This was a population-based cohort study using the Kailuan dataset, which comprises of medical claims and a biennially health checkup information from a Chinese cohort. A total of 98 554 individuals (mean age: 53.63 years) who had at least two health checkups with FBG measurement between 2006 and 2012 without preexisting heart failure were included. FBG variability was calculated using the variability independent of the mean, coefficient of variation, standard deviation, and average successive variability (ARV). Participants were divided into quartiles of ARV. Cox regression was used to identify heart failure. Over a mean follow-up of 6.27 years, 1218 individuals developed heart failure. The incidence of heart failure was 1.97 per 1000 person-years. After adjusting for baseline FBG and other potential confounders, individuals in the highest quartile of the ARV of FBG had 32.6% higher risk of developing heart failure compared to those in the lowest quartile (hazard ratio, 1.326; 95% confidence interval, 1.120-1.570). This association remained significant in patients with or without prevalent hypertension. In subgroup analyses, individuals who were younger (<65 years), without diabetes mellitus or chronic kidney disease, and with a body mass index<25 kg/m2 experienced a higher risk of heart failure.Conclusions: Our data demonstrated that high FBG variability is independently associated with the development of new-onset heart failure. Future studies should explore whether measures to reduce variability can lead to improve clinical outcomes. Trial registration: Chinese Clinical Trial Register, ChiCTR-TNRC-11001489. Registered on 24-08-2011.