Relationship of hemoglobin A1C and mortality in heart failure patients with diabetes.
Relationship of hemoglobin A1C and mortality in heart failure patients with diabetes.
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DOI：
10.1016/j.jacc.2009.04.049
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发表时间：
2009-07-28
影响因子：
24
通讯作者：
Deswal, Anita
中科院分区：
文献类型：
--
作者：
Aguilar, David;Bozkurt, Biykem;Ramasubbu, Kumudha;Deswal, Anita
旨在检查糖化血红蛋白 (HbA1C) 与已确诊心力衰竭 (HF) 的糖尿病患者不良后果之间的关系。尽管糖尿病和心力衰竭普遍共存，但之前检查 HbA1C 与该人群结局之间关系的研究有限，并且报告的结果不一致。我们通过对全国 5815 名患有心力衰竭和糖尿病的退伍军人进行回顾性研究，评估了 HbA1C 增加的五分位数 (Q1-Q5) 与死亡风险或心力衰竭住院风险之间的关联，这些退伍军人在退伍军人事务部医疗中心的门诊诊所接受治疗。随访两年时，第一季度（HbA1c ≤ 6.4）的患者死亡率为 25%，第二季度为 23%（6.4 < HbA1c ≤ 7.1），第三季度为 17.7%（7.1 < HbA1c ≤ 7.8），第四季度为 22.5%（7.8 < HbA1c ≤ 9.0），第 5 季度为 23.2%（HbA1c > 9.0）。调整潜在混杂因素后，与最低五分位数相比，中间五分位数（Q3）的死亡率降低（风险调整后 HR 0.73，95% CI 0.61 至 0.88，p=0.001）。 2 年心衰住院率随着 HbA1C 五分位数的增加而增加（第一季度 13.3%、第二季度 13.1%、第三季度 15.5%、第四季度 16.4% 和第五季度 18.2%），但在调整潜在混杂因素后，这种相关性并不具有统计学意义。合并心力衰竭的糖尿病患者死亡率与 HbA1C 之间的关联呈 U 形，血糖控制适度的患者死亡风险最低 (7.1% < HbA1C ≤ 7.8%)。未来的前瞻性研究有必要确定这些患者的最佳治疗目标。
To examine the relationship between glycosylated hemoglobin (HbA1C) and adverse outcomes in diabetic patients with established heart failure (HF). Despite the common co-existence of diabetes and HF, previous studies examining the association between HbA1C and outcomes in this population have been limited and have reported discrepant results. We assessed the association between increasing quintiles (Q1-Q5) of HbA1C and risk of death or risk of HF hospitalization by conducting a retrospective study in a national cohort of 5815 veterans with HF and diabetes treated in ambulatory clinics at Veterans Affairs medical centers. At two years of follow-up, death occurred in 25% of patients in Q1 (HbA1C ≤ 6.4), 23% in Q2 (6.4 < HbA1c ≤ 7.1), 17.7% in Q3 (7.1 < HbA1c ≤ 7.8), 22.5% in Q4 (7.8 < HbA1c ≤ 9.0), and 23.2% in Q5 (HbA1c > 9.0). After adjustment for potential confounders, the middle quintile (Q3) had reduced mortality when compared to the lowest quintile (risk-adjusted HR 0.73, 95% CI 0.61 to 0.88, p=0.001). HF hospitalization rates at 2 years increased with increasing quintiles of HbA1C (Q1 13.3%, Q2 13.1%, Q3 15.5%, Q4 16.4%, and Q5 18.2%), but this association was not statistically significant when adjusted for potential confounders. The association between mortality and HbA1C in diabetic patients with heart failure appears U-shaped, with the lowest risk of death in those patients with modest glucose control (7.1% < HbA1C ≤ 7.8%). Future prospective studies are necessary to define optimal treatment goals in these patients.
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