血糖状况与无糖尿病史老年人心力衰竭的发生：健康、衰老和身体成分研究。
Glycemic status and incident heart failure in elderly without history of diabetes mellitus: the health, aging, and body composition study.
机构信息
Emory University, Atlanta, GA, USA.
出版信息
J Card Fail. 2009 Sep;15(7):593-9. doi: 10.1016/j.cardfail.2009.03.001. Epub 2009 Apr 25.
BACKGROUND
It is unclear whether measures of glycemic status beyond fasting glucose (FG) levels improve incident heart failure (HF) prediction in patients without history of diabetes mellitus (DM).
METHODS AND RESULTS
The association of measures of glycemic status at baseline (including FG, oral glucose tolerance testing [OGTT], fasting insulin, hemoglobin A(1c) [HbA(1c)] levels, and homeostasis model assessment of insulin resistance [HOMA-IR] and insulin secretion [HOMA-B]) with incident HF, defined as hospitalization for new-onset HF, was evaluated in 2386 elderly participants without history of DM enrolled in the Health, Aging, and Body Composition Study (median age, 73 years; 47.6% men; 62.5% white, 37.5% black) using Cox models. After a median follow-up of 7.2 years, 185 (7.8%) participants developed HF. Incident HF rate was 10.7 cases per 1000 person-years with FG <100mg/dL, 13.1 with FG 100-125 mg/dL, and 26.6 with FG >or=126 mg/dL (P=.002; P=.003 for trend). In adjusted models (for body mass index, age, history of coronary artery disease and smoking, left ventricular hypertrophy, systolic blood pressure and heart rate [HR], and creatinine and albumin levels), FG was the strongest predictor of incident HF (adjusted HR per 10mg/dL, 1.10; 95% CI, 1.02-1.18; P=.009); the addition of OGTT, fasting insulin, HbA(1c), HOMA-IR, or HOMA-B did not improve HF prediction. Results were similar across race and gender. When only HF with left ventricular ejection fraction (LVEF) <or=40% was considered (n=69), FG showed a strong association in adjusted models (HR per 10mg/dL, 1.15; 95% CI, 1.03-1.29; P=.01). In comparison, when only HF with LVEF >40%, was considered (n=71), the association was weaker (HR per 10mg/dL, 1.05; 95% CI; 0.94-1.18; P=.41).
CONCLUSIONS
Fasting glucose is a strong predictor of HF risk in elderly without history of DM. Other glycemic measures provide no incremental prediction information.
背景
目前尚不清楚空腹血糖（FG）以外的血糖状态指标是否能改善无糖尿病病史患者的心力衰竭（HF）事件预测。
方法和结果
在没有糖尿病病史的 2386 名老年人参与者中（中位年龄 73 岁；47.6%为男性；62.5%为白人，37.5%为黑人），使用 Cox 模型评估基线时血糖状态指标（包括 FG、口服葡萄糖耐量试验（OGTT）、空腹胰岛素、糖化血红蛋白（HbA1c）水平以及胰岛素抵抗（HOMA-IR）和胰岛素分泌（HOMA-B）的稳态模型评估）与新发生 HF（定义为因新发 HF 而住院）的相关性。中位随访 7.2 年后，185 名（7.8%）参与者发生 HF。FG<100mg/dL 的患者 HF 发生率为 10.7 例/1000 人年，FG 为 100-125mg/dL 的患者 HF 发生率为 13.1 例/1000 人年，FG≥126mg/dL 的患者 HF 发生率为 26.6 例/1000 人年（P=.002；趋势 P=.003）。在调整后的模型中（用于身体质量指数、年龄、冠心病和吸烟史、左心室肥厚、收缩压和心率[HR]以及肌酐和白蛋白水平），FG 是 HF 事件最强的预测因子（每 10mg/dL 的调整 HR，1.10；95%CI，1.02-1.18；P=.009）；添加 OGTT、空腹胰岛素、HbA1c、HOMA-IR 或 HOMA-B 并不能改善 HF 预测。结果在种族和性别之间相似。当仅考虑左心室射血分数（LVEF）≤40%的 HF（n=69）时，FG 在调整后的模型中显示出较强的相关性（每 10mg/dL 的 HR，1.15；95%CI，1.03-1.29；P=.01）。相比之下，当仅考虑 LVEF>40%的 HF 时（n=71），相关性较弱（每 10mg/dL 的 HR，1.05；95%CI，0.94-1.18；P=.41）。
结论
空腹血糖是无糖尿病病史老年患者 HF 风险的有力预测指标。其他血糖指标不能提供额外的预测信息。
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