Glucose levels predict hospitalization for congestive heart failure in patients at high cardiovascular risk
Glucose levels predict hospitalization for congestive heart failure in patients at high cardiovascular risk
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DOI：
10.1161/circulationaha.106.661405
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发表时间：
2007-03-20
期刊：
影响因子：
37.8
通讯作者：
Teo, K.
中科院分区：
文献类型：
--
作者：
Held, C.;Gerstein, H. C.;Teo, K.
背景-糖尿病（DM）患者发生充血性心力衰竭（CHF）的风险较高。然而，血糖水平和充血性心力衰竭的人或没有糖尿病史之间的关系还没有得到很好的characteristic.Methods和结果，我们评估了空腹血糖和CHF住院治疗的风险之间的关联在随访期间，在高心血管风险和无CHF的患者参加了一个大规模的临床试验计划。在31546例患有≥ 1种冠状动脉、外周血管或脑血管疾病或糖尿病伴终末器官损害的高危受试者中评估基线空腹血糖水平，这些受试者正在参加2项正在进行的平行试验，评价替米沙坦、雷米普利或其联合治疗的效果（正在进行的替米沙坦单药治疗和与雷米普利联合治疗的全球终点试验[ONTARGET]; n = 25 620）以及替米沙坦相对于安慰剂在血管紧张素转换酶不耐受患者中的作用（在ACE不耐受心血管疾病受试者中开展的替米沙坦随机评估研究[ TRANSCEND]; n = 5926）。进行了对随机治疗设盲的中期分析，以比较基线空腹血糖与平均随访886天时校正的CHF事件发生率。进行多变量考克斯回归模型，相关性报告为风险比和95%置信区间。在所有受试者中（平均年龄67岁; 69%为男性），其中11708例（37%）在基线时患有已知DM，1006例（3.2%）在基线时新诊断为DM，668例患者在随访期间因CHF住院。校正年龄和性别后，空腹血糖升高1 mmol/L与CHF住院风险增加1.10倍相关（95%可信区间，1.08 ~ 1.12; P < 0.0001）。在校正了年龄、性别、吸烟、既往心肌梗死、高血压、腰臀比、肌酐、糖尿病、阿司匹林、β受体阻滞剂或他汀类药物的使用后，这种相关性仍然存在（危害比，1.05; 95%可信区间，1.02 ~ 1.08; P < 0.001）。这些数据为降糖在降低CHF风险方面的潜在直接有益作用提供了理论支持，并表明需要针对该问题进行特定研究。
Background-Patients with diabetes mellitus (DM) are at high risk of developing congestive heart failure (CHF). However, the relationships between glucose levels and CHF in people with or without a history of DM have not been well characterized.Methods and Results-We evaluated the associations between fasting plasma glucose and risk of hospitalization for CHF during follow-up in patients at high cardiovascular risk and without CHF enrolled in a large-scale clinical trials program. Baseline fasting plasma glucose levels were assessed in 31 546 high-risk subjects with >= 1 coronary, peripheral, or cerebrovascular disease or DM with end-organ damage who are participating in 2 ongoing parallel trials evaluating the effects of telmisartan, ramipril, or their combination (Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial [ONTARGET]; n = 25 620) and the effects of telmisartan against placebo in angiotensin-converting enzyme-intolerant patients (Telmisartan Randomized Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease [ TRANSCEND]; n = 5926). Interim analyses blinded for randomized treatment were performed to compare baseline fasting plasma glucose with the adjusted CHF event rate at a mean follow-up of 886 days. Multivariable Cox regression models were performed, and associations were reported as hazard ratios and 95% confidence intervals. Among all subjects (mean age, 67 years; 69% men), of whom 11 708 (37%) had known DM and 1006 (3.2%) had newly diagnosed DM at baseline, 668 patients were hospitalized for CHF during follow-up. After adjustment for age and sex, a 1-mmol/L-higher fasting plasma glucose was associated with a 1.10-fold-increased risk of CHF hospitalization (95% confidence interval, 1.08 to 1.12; P < 0.0001). The association persisted after adjustment for age, sex, smoking, previous myocardial infarction, hypertension, waist-to-hip ratio, creatinine, DM, and use of aspirin, beta-blockers, or statins (hazard ratio, 1.05; 95% confidence interval, 1.02 to 1.08; P < 0.001).Conclusions-Fasting plasma glucose is an independent predictor of hospitalization for CHF in high-risk subjects. These data provide theoretical support for potential direct beneficial effects of glucose lowering in reducing the risk of CHF and suggests the need for specific studies targeted at this issue.