Lifetime Risk of Heart Failure and Trends in Incidence Rates Among Individuals With Type 2 Diabetes Between 1995 and 2018.
Lifetime Risk of Heart Failure and Trends in Incidence Rates Among Individuals With Type 2 Diabetes Between 1995 and 2018.
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DOI：
10.1161/jaha.121.021230
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发表时间：
2021-11-02
影响因子：
5.4
通讯作者：
Andersson C
中科院分区：
文献类型：
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作者：
Schwartz B;Pierce C;Vasan RS;Schou M;Ibrahim M;Monahan K;Lyass A;Malmborg M;Gislason GH;Køber L;Torp-Pedersen C;Andersson C
关于2型糖尿病患者心力衰竭（HF）的终生风险以及发病率如何随时间变化的数据有限。我们使用全国范围的数据估计了1995年至2018年丹麦2型糖尿病成人中HF的累积发病率和发病率。总共确定了398422例2型糖尿病患者（49%为女性）。随访期间，36400例（9%）被诊断为HF，121459例（30%）因死亡而删失。使用Aalen-Johansen估计值，考虑死亡风险，计算出50岁时HF的估计剩余终生风险在女性中为24%（95% CI 22%-27%），在男性中为27%（25%-28%）。在观察期间，接受他汀类药物、血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂和二甲双胍治疗的患者比例从60%增加<30% to >。同样，HF的年发病率显著下降，老年人比年轻人下降更大（年龄>50岁与≤50岁分别为5%与2%; P<0.0001），女性比男性下降更大（5%与4%，P=0.02），但在有和无IHD的患者中相似（4%与4%，P=0.53）。目前，2型糖尿病患者HF的终生风险约为男性和女性的1/4。在过去几十年中，随着循证药物治疗的使用增加，发生HF的风险在几个亚组中下降，无论基础IHD如何，这表明最佳糖尿病治疗可以减轻HF风险。
There are limited data on the lifetime risk of heart failure (HF) in people with type 2 diabetes and how incidence has changed over time. We estimated the cumulative incidence and incidence rates of HF among Danish adults with type 2 diabetes between 1995 and 2018 using nationwide data. In total, 398 422 patients (49% women) with type 2 diabetes were identified. During follow‐up, 36 400 (9%) were diagnosed with HF and 121 459 (30%) were censored due to death. Using the Aalen‐Johansen estimators, accounting for the risk of death, the estimated residual lifetime risk of HF at age 50 years was calculated as 24% (95% CI 22%–27%) in women and 27% (25%–28%) in men. During the observational period, the proportion of patients treated with statins, angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers, and metformin increased from <30% to >60%. Similarly, the annual incidence rates of HF decreased significantly, with declines being greater in older versus younger individuals (5% versus 2% in age >50 versus ≤50 years, respectively; P<0.0001) and in women versus men (5% versus 4%, P=0.02), but similar in patients with and without IHD (4% versus 4%, P=0.53). The current lifetime risk of HF in type 2 diabetes approximates 1 in 4 for men and women. Paralleled by an increase in use of evidence‐based pharmacotherapy over the past decades, the risk of developing HF has declined across several subgroups and regardless of underlying IHD, suggesting that optimal diabetes treatment can mitigate HF risk.