Diabetes and incident heart failure in hypertensive and normotensive participants of the Strong Heart Study.
Diabetes and incident heart failure in hypertensive and normotensive participants of the Strong Heart Study.
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DOI：
10.1097/hjh.0b013e3283331169
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发表时间：
2010-02
影响因子：
4.9
通讯作者：
Howard BV
中科院分区：
文献类型：
--
作者：
de Simone G;Devereux RB;Chinali M;Lee ET;Galloway JM;Barac A;Panza JA;Howard BV
2型糖尿病被认为是心力衰竭（HF）的一个原因，但独立于心肌梗死、高血压和其他共存危险因素的直接因果关系证据研究较少。我们检验了糖尿病与高血压和并发心肌梗死（MI）无关的HF易感性的假设。我们评估了2740名参与者（1781名女性）12年的HF事件，这些参与者在强心研究队列的第一次检查时没有普遍的心血管（CV）或严重肾脏疾病。将并发心肌梗死作为竞争风险事件删失。1206人（44%）患有糖尿病，391人（14%）患有空腹血糖受损（IFG）。糖尿病参与者更常患有高血压和中心性肥胖（均p<0.0001）。在64名空腹血糖正常（NFG，6%）、26名（7%）IFG和201名糖尿病患者中确定了HF事件（17%，风险比[HR]= 4.04 vs. NFG; p<0.0001）。在调整年龄、性别、肥胖、中央脂肪分布、高血压、降压药物、普遍房颤、GFR、尿白蛋白/肌酸酐比、血浆胆固醇、Hb 1Ac、吸烟习惯、饮酒、教育水平和体力活动的考克斯分析中，糖尿病与HF事件的风险相关2倍，比NFG高（HR=2.45，p<0.0001）。即使将并发心肌梗死（n=221）作为竞争风险事件删失，糖尿病患者发生HF的风险仍比NFG高1.5倍（p<0.03），与高血压患者HF的校正HR相似。2型糖尿病是HF的一个强有力的独立危险因素。糖尿病受试者的HF风险不能完全由MI事件和共存的CV风险因素解释。应研究和确定与糖尿病和损害心脏功能直接相关的机制。
Type 2 diabetes is accepted as a cause of heart failure (HF), but direct cause-effect evidence independent of incident myocardial infarction, hypertension and other coexisting risk factors is less well studied. We tested the hypothesis that diabetes predisposes to HF independently of hypertension and intercurrent myocardial infarction (MI). We evaluated 12-year incident HF in 2740 participants (1781 women) without prevalent cardiovascular (CV) or severe kidney disease, at the time of the 1st exam of the Strong Heart Study cohort. Intercurrent myocardial infarction was censored as a competing risk event. Diabetes was present in 1206 individuals (44%), and impaired fasting glucose (IFG) in 391 (14%). Diabetic participants more frequently had hypertension and central obesity (both p<0.0001). Incident HF was ascertained in 64 participants with normal fasting glucose (NFG, 6%), 26 (7%) with IFG and 201 with diabetes (17%, Hazard ratio [HR]= 4.04 vs. NFG; p<0.0001). In Cox analysis adjusting for age, sex, obesity, central fat distribution, hypertension, antihypertensive medications, prevalent atrial fibrillation, GFR, urinary albumin/creatinine ratio, plasma cholesterol, Hb1Ac, smoking habit, alcohol use, educational level and physical activity, diabetes was associated with a 2-fold greater risk of incident HF than NFG (HR=2.45, p<0.0001). Diabetes maintained 1.5-fold greater risk of HF than NFG (p<0.03) even when intercurrent myocardial infarction (n=221) was censored as a competing risk event, similar to the adjusted HR for HF in hypertension. Type 2 diabetes is a potent, independent risk factor for HF. Risk of HF in diabetic subjects cannot be fully explained by incident MI and coexisting CV risk factors. Mechanisms directly related to diabetes and impairing cardiac function should be studied and identified.