Gustafsson Ida, Brendorp Bente, Seibaek Marie, Burchardt Hans, Hildebrandt Per, Køber Lars, Torp-Pedersen Christian
Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Denmark.
J Am Coll Cardiol. 2004 Mar 3;43(5):771-7. doi: 10.1016/j.jacc.2003.11.024.
The purpose of this study was to investigate the influence of diabetes on long-term mortality in a large cohort of patients hospitalized with heart failure (HF).
Diabetes is common in HF patients, but information on the prognostic effect of diabetes is sparse.
The study is an analysis of survival data comprising 5,491 patients consecutively hospitalized with new or worsening HF and screened for entry into the Danish Investigations of Arrhythmia and Mortality on Dofetilide (DIAMOND). Screening, which included obtaining an echocardiogram in 95% of the patients, took place at Danish hospitals between 1993 and 1995. The follow-up time was five to eight years.
A history of diabetes was found in 900 patients (16%), 41% of whom were female. Among the diabetic patients, 755 (84%) died during follow-up, compared with 3,200 (70%) among the non-diabetic patients, resulting in a risk ratio (RR) of death in diabetic patients of 1.5 (95% confidence interval [CI] 1.4 to 1.6, p < 0.0001). In a multivariate analysis, the RR of death in diabetic patients was 1.5 (CI 1.3 to 1.76, p < 0.0001), but a significant interaction between diabetes and gender was found. Diabetes increased the mortality risk more in women than in men, with the RR for diabetic men being 1.4 (95% CI 1.3 to 1.6, p < 0.0001) and 1.7 for diabetic women (95% CI 1.4 to 1.9, p < 0.0001). The effect of diabetes on mortality was similar in patients with depressed and normal left ventricular systolic function.
Diabetes is a potent, independent risk factor for mortality in patients hospitalized with HF. The excess risk in diabetic patients appears to be particularly prominent in females.
本研究旨在调查糖尿病对大量因心力衰竭（HF）住院患者长期死亡率的影响。
糖尿病在HF患者中很常见，但关于糖尿病预后影响的信息却很少。
本研究是对生存数据的分析，包括5491例因新发或病情恶化的HF连续住院并接受丹麦多非利特心律失常和死亡率调查（DIAMOND）筛选的患者。筛选工作于1993年至1995年在丹麦医院进行，95%的患者接受了超声心动图检查。随访时间为5至8年。
900例患者（16%）有糖尿病史，其中41%为女性。在糖尿病患者中，755例（84%）在随访期间死亡，而非糖尿病患者中有3200例（70%）死亡，糖尿病患者的死亡风险比（RR）为1.5（95%置信区间[CI]1.4至1.6，p<0.0001）。在多变量分析中，糖尿病患者的死亡RR为1.5（CI 1.3至1.76，p<0.0001），但发现糖尿病与性别之间存在显著交互作用。糖尿病对女性死亡率的增加作用大于男性，糖尿病男性的RR为1.4（95%CI 1.3至1.6，p<0.0001），糖尿病女性为1.7（95%CI 1.4至1.9，p<0.0001）。糖尿病对左心室收缩功能降低和正常的患者死亡率的影响相似。
糖尿病是因HF住院患者死亡的一个强有力的独立危险因素。糖尿病患者的额外风险在女性中似乎尤为突出。
