Novel metabolic risk factors for incident heart failure and their relationship with obesity
Novel metabolic risk factors for incident heart failure and their relationship with obesity
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DOI：
10.1016/j.jacc.2007.12.048
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发表时间：
2008-05-06
影响因子：
24
通讯作者：
Lima, Joao A. C.
中科院分区：
文献类型：
--
作者：
Bahrami, Hossein;Bluemke, David A.;Lima, Joao A. C.
目的本研究的目的是确定代谢综合征、炎症标志物和胰岛素抵抗与充血性心力衰竭(CHF)发病的相关性，并探讨这些危险因素是否可能在肥胖和CHF之间提供联系。背景近年来，人们对新的危险因素如全身炎症、胰岛素抵抗和蛋白尿在CHF的病理生理中的潜在作用及其与肥胖的关系越来越感兴趣。方法MESA(多民族动脉粥样硬化研究)是一项基于社区的多中心队列研究，参与者包括4个种族的6814名参与者(年龄45-84岁，3601名女性)：高加索人、非裔美国人、拉美裔美国人、西班牙裔美国人、和华裔美国人。参与者是在2000至2002年间从6个美国社区招募的。中位随访时间为4年。有症状性心血管疾病病史的参与者被排除在外。用COX比例风险模型分析代谢综合征、炎症标志物、胰岛素抵抗和蛋白尿与CHF发生的关系，独立于已确定的危险因素(年龄、性别、高血压、糖尿病、左室肥厚、肥胖、血清总胆固醇和吸烟)、暂时性心肌梗死和左心室结构和功能的基线磁共振成像参数。结果79名参与者在随访期间发生了CHF，其中26名(32.9%)在CHF之前有心肌梗死，65%的患者有保留的心功能(左心室射血分数和GT=40%)。在多变量分析中，血清白细胞介素6(危险比[HR]为1标准差1.50，95%可信区间[CI]1.10~2.03)或C反应蛋白(HR=1标准差1.38，95%可信区间1.01~1.86)和大量蛋白尿(HR 4.31，95%可信区间1.58~11：76)是CHF的预测因素，独立于肥胖和其他已建立的危险因素。虽然肥胖与CHF的发生显著相关，但在模型中加入炎症标志物(白介素6或C反应蛋白)后，这种关联不再显著。结论炎症标志物和蛋白尿是CHF的独立预测因素。肥胖与充血性心力衰竭的关系可能与炎症相关的病理生理途径有关。
Objectives The objectives of this study were to determine the associations of the metabolic syndrome, inflammatory markers, and insulin resistance with incident congestive heart failure (CHF), beyond established risk factors, and to examine whether these risk factors may provide the link between obesity and CHF.Background Recently, increasing interest has emerged on the potential role of novel risk factors such as systemic inflammation, insulin resistance, and albuminuria in the pathophysiology of CHF and their relationship with obesity.Methods The MESA (Multi-Ethnic Study of Atherosclerosis) study is a community-based multicenter cohort study of 6,814 participants (age 45 to 84 years, 3,601 women) of 4 ethnicities: Caucasians, African Americans, Hispanics, and Chinese Americans. Participants were recruited between 2000 and 2002 from 6 U.S. communities. Median follow-up time was 4 years. Participants with history of symptomatic cardiovascular disease were excluded. Cox proportional hazards models were used to analyze the associations of the metabolic syndrome, inflammatory markers, insulin resistance, and albuminuria with incident CHF, independent of established risk factors (age, gender, hypertension, diabetes mellitus, left ventricular hypertrophy, obesity, serum total cholesterol, and smoking), an interim myocardial infarction, and baseline magnetic resonance imaging parameters of left ventricular structure and function.Results A total of 79 participants developed CHF during follow-up, and 26 participants (32.9%) had a myocardial infarction prior to CHF and 65% of the cases had CHF with preserved function (left ventricular ejection fraction >= 40%). In multivariable analyses, serum interieukin-6 (hazard ratio [HR] for 1 standard deviation 1.50, 95% confidence interval [CI] 1.10 to 2.03) or C-reactive protein (HR for 1 standard deviation 1.38; 95% CI 1.01 to 1.86) and macroalbuminuria (HR 4.31, 95% CI 1.58 to 11:76) were predictors of CHF, independent of obesity and the other established risk factors. Although obesity was significantly associated with incident CHF, this association was no longer significant after adding inflammatory, markers (interleukin-6 or C-reactive protein) to the model.Conclusions Inflammatory markers and albuminuria are independent predictors of CHF. The association of obesity and CHF may be related to pathophysiologic pathways associated with inflammation.