Leung Alexander A, Eurich Dean T, Lamb Darcy A, Majumdar Sumit R, Johnson Jeffrey A, Blackburn David F, McAlister Finlay A
Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada.
J Card Fail. 2009 Mar;15(2):152-7. doi: 10.1016/j.cardfail.2008.10.004. Epub 2008 Nov 28.
Although thiazolidinediones precipitate fluid retention in clinical trials, current guidelines advocate their use for patients with diabetes who are felt to be at low risk for heart failure (HF).
An inception cohort study was conducted using Saskatchewan Health databases spanning the years 1991 to 1999 (before use of thiazolidinediones) to compare incidence rates of new HF in patients with recent-onset diabetes vs. the general population. Of 12,272 patients with new-onset type 2 diabetes (mean age 63 years), 718 (6%) developed HF over 5.2 years; median time until development of HF was 2.8 years. The adjusted rate of incident HF for the diabetes cohort was 794 cases per 100,000 person years compared with 275 per 100,000 person-years in the general population. Patients with recent-onset diabetes were more likely to develop HF than the general population (adjusted rate ratio 2.9; 95% CI 2.6 to 3.2) and the relative risk was most pronounced in those younger than 60 years (adjusted rate ratio 12.8; 95% CI 8.2 to 20.0).
The incidence of HF is relatively high within 5 years of diabetes onset, calling into question the ease with which individuals with diabetes "at low risk of HF" can be identified.
尽管噻唑烷二酮类药物在临床试验中会引发液体潴留，但当前指南仍提倡将其用于被认为心力衰竭（HF）风险较低的糖尿病患者。
利用萨斯喀彻温省1991年至1999年（噻唑烷二酮类药物使用之前）的健康数据库进行了一项队列起始研究，以比较近期发病的糖尿病患者与普通人群中新发HF的发病率。在12272例新发2型糖尿病患者（平均年龄63岁）中，718例（6%）在5.2年期间发生了HF；发生HF的中位时间为2.8年。糖尿病队列中HF的调整发病率为每10万人年794例，而普通人群中为每10万人年275例。近期发病的糖尿病患者比普通人群更易发生HF（调整发病率比为2.9；95%可信区间为2.6至3.2），且相对风险在60岁以下人群中最为显著（调整发病率比为12.8；95%可信区间为8.2至20.0）。
糖尿病发病后5年内HF的发病率相对较高，这使人质疑能否轻易识别出“HF低风险”的糖尿病患者。
