Impact of diabetes and sex in heart failure with reduced ejection fraction patients from the ASIAN-HF registry
Impact of diabetes and sex in heart failure with reduced ejection fraction patients from the ASIAN-HF registry
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DOI：
10.1002/ejhf.1358
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发表时间：
2019-03-01
影响因子：
18.2
通讯作者：
Lam, Carolyn S. P.
中科院分区：
文献类型：
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作者：
Chandramouli, Chanchal;Teng, Tiew-Hwa Katherine;Lam, Carolyn S. P.
目的：研究伴/不伴糖尿病（DM）患者的临床特征、超声心动图特征、生活质量和1年死亡或心力衰竭（HF）住院结局的性别差异。方法和结果（ASIAN-HF）登记研究中，5255例症状性HF伴射血分数降低（HFrEF）患者（平均年龄59.6 ± 13.1，78%为男性）按DM状态分层，以实现研究目的。尽管亚洲男性（43%）和女性（42%）的糖尿病患病率相似，但女性体重指数较低时患糖尿病的几率比男性高（>= 23 vs.>= 27.5 kg/m2，P-交互作用= 0.014）。与男性相比，女性中DM与慢性肾脏疾病的相关性更强[校正的比值比（OR）1.85，95%置信区间（CI）1.33-2.57 vs. OR 1.32，95% CI 1.11-1.56，P-相互作用= 0.009]。性别也改变了糖尿病和左心室几何形状之间的关系（P-交互作用= 0.003），其中糖尿病与女性比男性更同心的左心室几何形状相关。无论是糖尿病组还是非糖尿病组，女性的生活质量均低于男性（P < 0.001）。女性与男性相比，DM与1年时更差的复合结局相关[风险比（HR）1.79，95% CI 1.24-2.60 vs. HR 1.32，95% CI 1.12-1.56;结论亚洲女性HFrEF患者更容易患糖尿病，尽管有瘦体重指数，与男性相比，慢性肾脏疾病的负担更大，左心室几何形状更同心。此外，糖尿病赋予更差的生活质量，无论性别，和更大的风险，在女性比男性的不良后果。这些数据强调了对HF患者的糖尿病采取性别特异性方法的必要性。
Aims To examine sex differences in clinical characteristics, echocardiographic features, quality of life and 1-year death or heart failure (HF) hospitalization outcomes in patients with/without diabetes mellitus (DM).Methods and results Utilizing the Asian Sudden Cardiac Death in HF (ASIAN-HF) registry, 5255 patients (mean age 59.6 +/- 13.1, 78% men) with symptomatic HF with reduced ejection fraction (HFrEF) were stratified by DM status to address the research aims. Despite similar prevalence of DM between Asian men (43%) and women (42%), the odds of DM increased at lower body mass index in women vs. men (>= 23 vs. >= 27.5 kg/m(2), P-interaction = 0.014). DM was more strongly related to chronic kidney disease in women vs. men [adjusted odds ratio (OR) 1.85, 95% confidence interval (CI) 1.33-2.57 vs. OR 1.32, 95% CI 1.11-1.56, P-interaction = 0.009]. Sex also modified the relationship between DM and left ventricular geometry (P-interaction = 0.003), whereby DM was associated with amore concentric left ventricular geometry in women than men. Women had lower quality of life than men (P < 0.001), in both DM and non-DM groups. DM was associated with worse composite outcomes at 1 year in women vs. men [hazard ratio (HR) 1.79, 95% CI 1.24-2.60 vs. HR 1.32, 95% CI 1.12-1.56; P-interaction = 0.005).Conclusions Asian women with HFrEF were more likely to have DM despite a lean body mass index, a greater burden of chronic kidney disease and more concentric left ventricular geometry, compared to men. Furthermore, DM confers worse quality of life, irrespective of sex, and a greater risk of adverse outcomes in women than men. These data underscore the need for sex-specific approaches to diabetes in patients with HF.