Duration of Diabetes and Incident Heart Failure: The ARIC (Atherosclerosis Risk In Communities) Study.
Duration of Diabetes and Incident Heart Failure: The ARIC (Atherosclerosis Risk In Communities) Study.
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DOI：
10.1016/j.jchf.2021.06.005
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发表时间：
2021-08
期刊：
影响因子：
--
通讯作者：
Ndumele CE
中科院分区：
文献类型：
--
作者：
Echouffo-Tcheugui JB;Zhang S;Florido R;Hamo C;Pankow JS;Michos ED;Goldberg RB;Nambi V;Gerstenblith G;Post WS;Blumenthal RS;Ballantyne CM;Coresh J;Selvin E;Ndumele CE
这项研究评估了糖尿病病程与发生心力衰竭(HF)的关系。糖尿病会增加心力衰竭的风险。然而，糖尿病病程对发生心衰的独立影响尚不清楚。我们纳入了9,734名ARIC患者(平均年龄63岁，女性占58%，黑人占22%)，在没有心力衰竭或冠心病(CHD)的情况下第四次ARIC访问(1996-1998)。我们计算了第4次就诊时的糖尿病病程(基线)，利用相隔3年的前4次ARIC就诊时的糖尿病状况，以及在第1次就诊前确诊的糖尿病患者的自我报告诊断日期。我们使用COX回归来估计糖尿病病程与心力衰竭事件的关系，考虑到并发CHD和其他危险因素。我们进行了按年龄(65岁或≥65岁)、种族、性别和血糖控制(HbA1C一致性为7%，与HbA1C≥为7%)分层的分析，并对交互作用进行了测试。在22.5年的随访中，共有1,968例心衰事件。与无糖尿病者相比，糖尿病病程越长，心衰风险越高，≥病程15年者发生心衰的风险最高(HR=2.82，95%CI：2.25，3.63)。糖尿病病程每延长5年，心衰风险相对增加17%(95%可信区间：1.11，1.22)。在不同的HF亚型中也观察到类似的结果。65岁的人群中，心力衰竭与糖尿病病程的关联性更强，糖化血红蛋白≥为7%的女性，体重指数≥为30 kg/m2，黑人(均为P交互作用)。推迟糖尿病的发病可能会增加预防心力衰竭的努力，而改善心力衰竭预后的治疗可能针对那些糖尿病病程较长的人。
The study assessed the association of diabetes duration with incident heart failure (HF). Diabetes increases HF risk. However, the independent effect of diabetes duration on incident HF is unknown. We included 9,734 participants (mean age 63, 58% female, 22% Black) at ARIC Visit 4 (1996-1998) without HF or coronary heart disease (CHD). We calculated diabetes duration at Visit 4 (baseline), utilizing diabetes status at the first four ARIC visits spaced 3 years apart, and self-reported diagnosis date for those with diabetes diagnosed before Visit 1. We used Cox regression to estimate associations of diabetes duration with incident HF, accounting for intercurrent CHD and other risk factors. We performed analyses stratified by age (<65 or ≥65 years), race, sex and glycemic control (HbA1C consistently <7%, vs. HbA1C ≥7%), with tests for interaction. Over 22.5 years of follow-up, there were 1,968 HF events. Compared to those without diabetes, HF risk rose with longer diabetes duration, with the highest risk among those with ≥15 years duration (HR of 2.82, 95% CI: 2.25, 3.63). Each 5-years longer diabetes duration was associated with a 17% (95% CI: 1.11, 1.22) relative increase in HF risk. Similar results were observed across HF subtypes. The HF and diabetes duration associations were stronger among those aged <65 years, with HbA1C ≥7% women, with a BMI ≥30 kg/m2, and Blacks (all P interactions <0.05). Delaying diabetes onset may augment HF prevention efforts, and therapies to improve HF outcomes might target those with long diabetes duration.
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影响因子：
158.5
作者：
Knowler, WC;Barrett-Connor, E;Nathan, DM
通讯作者：
Nathan, DM
影响因子：
16.2
作者：
Fox, CS;Sullivan, L;Wilson, PWF
通讯作者：
Wilson, PWF
影响因子：
8.2
作者：
Bugger, Heiko;Abel, E. Dale
通讯作者：
Abel, E. Dale
影响因子：
8.2
作者：
Pazin-Filho, A.;Kottgen, A.;Bertoni, A. G.;Russell, S. D.;Selvin, E.;Rosamond, W. D.;Coresh, J.
通讯作者：
Coresh, J.
影响因子：
120.7
作者：
Menke, Andy;Casagrande, Sarah;Cowie, Catherine C.
通讯作者：
Cowie, Catherine C.