Effect of baseline systolic blood pressure (SBP) in all-cause mortality in the Valsartan Heart Failure Trial. Reprinted from Anand et al.60 Copyright 2008, American Heart Association, Inc. Management of Comorbidities in Chronic Heart Failure CLINICAL STATEMENTS AND GUIDELINES (EF <30%), SBP has a linear association with mortality, with higher SBP being associated with better survival and lower SBP being associated with worse mortality. Diabetes Mellitus and HF Association of Diabetes Mellitus With the Development of Incident HF Multiple observational studies have demonstrated that diabetes mellitus is associated with an increased risk for the development of HF.94 98 In the Framingham Heart Study, diabetes mellitus was associated with a nearly 2-fold greater risk of HF in men and a nearly 4-fold in- creased risk of HF in women independently of the pres- ence of hypertension, coronary artery disease, LV hy- pertrophy, and valvular heart disease.95 In the NHANES (National Health and Nutrition Examination Survey) Epide- miologic Follow-Up Study, diabetes mellitus was indepen- dently associated with an 80% increased risk of HF.94 In the Framingham Heart Study, the population-attributable risk for HF associated with diabetes mellitus was 6% in men and 12% in women.18,19 Studies have also demonstrated that milder eleva- tions in glucose and abnormalities in insulin resistance, even in the absence of overt diabetes mellitus, are as- sociated with an increased risk for HF.99,100 In individuals without known diabetes mellitus or HF at baseline in the ARIC study (Atherosclerosis Risk in Communities), the risk of incident HF was higher in individuals with hemo- CI, 0.98 1.37) compared with those with an HbA1c of (Table 5). The mechanisms contributing to the greater degree of HF in individuals with diabetes mellitus are likely mul- tifactorial and include the commonly shared HF risk factors of hypertension, coronary artery disease, renal Figure 3. 