***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Heart failure incidence increases with advancing age , and approximately half of patients with heart failure have preserved left ventricular ejection fraction . Although diastolic dysfunction plays a role in heart failure with preserved ejection fraction , little is known about age-dependent longitudinal changes in diastolic function in community population s. OBJECTIVE To measure changes in diastolic function over time and to determine the relationship between diastolic dysfunction and the risk of subsequent heart failure . DESIGN , SETTING , AND PARTICIPANTS Population -based cohort of participants enrolled in the Olmsted County Heart Function Study . R and omly selected participants 45 years or older ( N = 2042 ) underwent clinical evaluation , medical record abstract ion , and echocardiography ( examination 1 [ 1997 - 2000 ] ) . Diastolic left ventricular function was grade d as normal , mild , moderate , or severe by vali date d Doppler techniques . After 4 years , participants were invited to return for examination 2 ( 2001 - 2004 ) . The cohort of participants returning for examination 2 ( n = 1402 of 1960 surviving [ 72 % ] ) then underwent follow-up for ascertainment of new-onset heart failure ( 2004 - 2010 ) . MAIN OUTCOME MEASURES Change in diastolic function grade and incident heart failure . RESULTS During the 4 ( SD , 0.3 ) years between examinations 1 and 2 , diastolic dysfunction prevalence increased from 23.8 % ( 95 % confidence interval [ CI ] , 21.2%-26.4 % ) to 39.2 % ( 95 % CI , 36.3%-42.2 % ) ( P < .001 ) . Diastolic function grade worsened in 23.4 % ( 95 % CI , 20.9%-26.0 % ) of participants , was unchanged in 67.8 % ( 95 % CI , 64.8%-70.6 % ) , and improved in 8.8 % ( 95 % CI , 7.1%-10.5 % ) . Worsened diastolic dysfunction was associated with age 65 years or older ( odds ratio , 2.85 [ 95 % CI , 1.77 - 4.72 ] ) . During 6.3 ( SD , 2.3 ) years of additional follow-up , heart failure occurred in 2.6 % ( 95 % CI , 1.4%-3.8 % ) , 7.8 % ( 95 % CI , 5.8%-13.0 % ) , and 12.2 % ( 95 % CI , 8.5%-18.4 % ) of persons whose diastolic function normalized or remained normal , remained or progressed to mild dysfunction , or remained or progressed to moderate or severe dysfunction , respectively ( P < .001 ) . Diastolic dysfunction was associated with incident heart failure after adjustment for age , hypertension , diabetes , and coronary artery disease ( hazard ratio , 1.81 [ 95 % CI , 1.01 - 3.48 ] ) . CONCLUSIONS In a population -based cohort undergoing 4 years of follow-up , prevalence of diastolic dysfunction increased . Diastolic dysfunction was associated with development of heart failure during 6 years of subsequent follow-up Background —Although type 2 diabetes mellitus is a risk factor for developing congestive heart failure , the mechanism leading to heart failure is unclear . We examined the prevalence of left ventricular ( LV ) systolic and diastolic dysfunction in patients with type 2 diabetes mellitus in relation to vascular function and myocardial perfusion . Methods and Results —A prospect i ve observational study of 305 patients with type 2 diabetes mellitus ( diabetes duration , 4.5±5.3 years ) referred consecutively to a diabetes clinic were screened  for  LV systolic and diastolic function by echocardiography .  Vascular function was estimated using noninvasive estimation of pulse pressure , carotid arterial compliance , total arterial compliance , and valvulo-arterial impedance . The prevalences of LV diastolic dysfunction and left atrial ( LA ) volume index > 32 mL/m2 were 40 % and 32 % , respectively . The prevalence of myocardial ischemia on myocardial perfusion scintigraphy was more frequent in patients with grade 2 diastolic dysfunction and LA volume index > 32 mL/m2 compared with those having normal or grade 1 diastolic dysfunction ( P=0.002 ) or LA volume index ≤32 mL/m2 ( P<0.001 ) , respectively . Predictors of grade 2 diastolic dysfunction and LA dilation were summed stress score on myocardial perfusion scintigraphy , total arterial compliance , and valvulo-arterial impedance , whereas pulse pressure and carotid arterial compliance were not , after adjusting for age , sex , and diabetes duration . On multivariable modeling , summed stress score ( P<0.001 ) and valvulo-arterial impedance ( P=0.027 ) remained predictors of grade 2 diastolic dysfunction , and only summed stress score ( P<0.001 ) was a predictor of LA dilation . Conclusions —Abnormal LV filling is closely associated with abnormal myocardial perfusion on myocardial perfusion scintigraphy , whereas the association of LV filling with vascular function is less prominent . Clinical Trial Registration —The trial has been registered at www . clinical trial.gov with Identifier : NCT00298844 OBJECTIVES The study sought to assess the primary preventive effect of neurohumoral therapy in high-risk diabetic patients selected by N-terminal pro-B-type natriuretic peptide ( NT-proBNP ) . BACKGROUND Few clinical trials have successfully demonstrated the prevention of cardiac events in patients with diabetes . One reason for this might be an inaccurate selection of patients . NT-proBNP has not been assessed in this context . METHODS A total of 300 patients with type 2 diabetes , elevated NT-proBNP ( > 125 pg/ml ) but free of cardiac disease were r and omized . The " control " group was cared for at 4 diabetes care units ; the " intensified " group was additionally treated at a cardiac outpatient clinic for the up-titration of renin-angiotensin system ( RAS ) antagonists and beta-blockers . The primary endpoint was hospitalization/death due to cardiac disease after 2 years . RESULTS At baseline , the mean age of the patients was 67.5 ± 9 years , duration of diabetes was 15 ± 12 years , 37 % were male , HbA1c was 7 ± 1.1 % , blood pressure was 151 ± 22 mm Hg , heart rate was 72 ± 11 beats/min , median NT-proBNP was 265.5 pg/ml ( interquartile range : 180.8 to 401.8 pg/ml ) . After 12 months there was a significant difference between the number of patients treated with a RAS antagonist/beta-blocker and the dosage reached between groups ( p < 0.0001 ) . Blood pressure was significantly reduced in both ( p < 0.05 ) ; heart rate was only reduced in the intensified group ( p = 0.004 ) . A significant reduction of the primary endpoint ( hazard ratio : 0.351 ; 95 % confidence interval : 0.127 to 0.975 , p = 0.044 ) was visible in the intensified group . The same was true for other endpoints : all-cause hospitalization , unplanned cardiovascular hospitalizations/death ( p < 0.05 for all ) . CONCLUSIONS Accelerated up-titration of RAS antagonists and beta-blockers to maximum tolerated dosages is an effective and safe intervention for the primary prevention of cardiac events for diabetic patients pre-selected using NT-proBNP . ( Nt-proBNP Guided Primary Prevention of CV Events in Diabetic Patients [ PONTIAC ] ; NCT00562952 ) AIMS To determine whether the risk of adverse cardiovascular ( CV ) outcomes associated with diabetes differs in patients with low and preserved ejection fraction ( EF ) heart failure ( HF ) . METHODS AND RESULTS We analysed outcomes in the C and esartan in Heart failure- Assessment of Reduction in Mortality and morbidity ( CHARM ) programme which r and omized 7599 patients with symptomatic HF and a broad range of EF . The prevalence of diabetes was 28.3 % in patients with preserved EF ( > 40 % ) and 28.5 % in those with low EF ( < or=40 % ) . Diabetes was associated with a greater relative risk of CV death or HF hospitalization in patients with preserved EF [ hazard ratio ( HR ) 2.0 ( 1.70 - 2.36 ) ] than in patients with low EF [ HR 1.60 ( 1.44 - 1.77 ) ; interaction test P = 0.0009 ] . For all-cause mortality , the risk conferred by diabetes was similar in both low and preserved EF groups . The effect of c and esartan in reducing CV morbidity and mortality outcomes was not modified by having diabetes at baseline ( P = 0.09 test for interaction ) . CONCLUSION Diabetes was an independent predictor of CV morbidity and mortality in patients with HF , regardless of EF . The relative risk of CV death or HF hospitalization conferred by diabetes was significantly greater in patients with preserved when compared with those with low EF HF Background : The incidence of heart failure in diabetic subjects is high even in the absence of hypertension and coronary artery disease . Aims : The purpose of this study was to study the incidence of diastolic dysfunction in diabetic subjects and its relation to age , duration of diabetes mellitus ( DM ) , Glycosylated hemoglobin ( HbA1c ) levels , obesity indices and diabetic microangiopathies . Setting s and Design : This was a case control prospect i ve study conducted at the teaching hospital during a one year period . Material s and Methods : A total of 127 subjects ( case ) with type 2 diabetes of more than five years duration were studied . Total 100 healthy subjects were included as the control group .  Echocardiography was performed to assess  left ventricular diastolic function . Results : Out of the total 127 subjects , 69 ( 54.33 % ) from the case group had diastolic dysfunction , and 11 % amongst 100 in the control group population showed the diastolic dysfunction ( P < 0.001 ) . Patients with a longer duration of DM ( of 11 to 15 years ) had a higher prevalence of diastolic dysfunction ( P < 0.02 ) . Subjects with high waist circumference and high waist to hip ratio had statistically significant diastolic dysfunction with ‘ P ’ = 0.001 and ‘ P ’ = < 0.02 respectively . Subjects with HbA1c > 7.5 % had a higher prevalence of diastolic dysfunction than subjects with HbA1c < 7.5 % ( P < 0.02 ) . Diastolic dysfunction was present in majority of the subjects with autonomic neuropathy and retinopathy . Conclusions : Present study reveals high incidence of diastolic dysfunction in asymptomatic diabetic ; subjects and , this finding was correlated with the duration of diabetes , HbA1c levels , obesity indices and diabetic microangiopathies . We conclude that early diagnosis and institution of treatment will reduce morbidity and improve the outcomes , and prevent future heart failure OBJECTIVE In the course of performing systematic review s on the prevalence of low back and neck pain , we required a tool to assess the risk of study bias . Our objectives were to ( 1 ) modify an existing checklist and ( 2 ) test the final tool for interrater agreement . STUDY DESIGN AND SETTING The final tool consists of 10 items addressing four domains of bias plus a summary risk of bias assessment . Two research ers tested the interrater agreement of the tool by independently assessing 54 r and omly selected studies .  Interrater agreement overall and for each individual item was assessed using the proportion of agreement and Kappa statistic . RESULTS Raters found the tool easy to use , and there was high interrater agreement : overall agreement was 91 % and the Kappa statistic was 0.82 ( 95 % confidence interval : 0.76 , 0.86 ) . Agreement was almost perfect for the individual items on the tool and moderate for the summary assessment . CONCLUSION We have addressed a research gap by modifying and testing a tool to assess risk of study bias . Further research may be useful for assessing the applicability of the tool across different conditions BACKGROUND Diabetic cardiomyopathy defined as either systolic or diastolic dysfunction in otherwise healthy diabetic persons is not clearly understood . The prevalence and outcomes of this disease in a community-based population have not been defined . METHODS AND RESULTS Cross-sectional survey of 2042 r and omly selected residents of Olmsted County , Minnesota , aged 45 years or older between June 1997 and September 2000 . All patients underwent Doppler echocardiographic assessment of systolic and diastolic function . 
    Output:
    
Conclusion : The prevalence of left ventricular diastolic dysfunction among type 2 diabetes patients is similarly high in men and women , while heart failure with preserved ejection fraction seems to be more common in women than men , at least in community people with type 2 diabetes