Department of Cardiology, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, DK 2900 Hellerup, Denmark.
Eur J Heart Fail. 2010 Dec;12(12):1333-8. doi: 10.1093/eurjhf/hfq160. Epub 2010 Sep 23.
Heart failure (HF) is associated with increased insulin resistance, but the consequences of HF for development of diabetes are not well studied. The aim of the present study was to investigate the relationship between HF severity and risk of developing diabetes in a nationwide cohort of patients with myocardial infarction (MI).
Patients discharged from first-time MI during 1997-2006 and not previously treated with glucose-lowering medications (GLM) or loop diuretics were identified from Danish nationwide registers. Heart failure severity was determined by loop diuretic dosage after discharge. Patients were followed until first claimed prescription of GLM, death, or until the end of 2006. The cohort comprised 50 874 patients. A total of 3006 (6%) had mild (loop-diuretic dosage≤40 mg/day), 5383 (11%) moderate (>40-120 mg/day), and 1127 (2%) severe (>120 mg/day) HF. During follow-up, 2531 (5%) patients developed diabetes. Increasing HF severity was associated with increased risk of diabetes, but the use of renin-angiotensin system inhibitors (RASi) attenuated the risk (P-value for interaction between the HF group and RASi<0.05). Compared with no HF, the adjusted hazard ratios (95% confidence interval) for the development of diabetes were 1.34 (1.11-1.63), 1.63 (1.40-1.90), and 1.68 (1.25-2.25) for mild, moderate, and severe HF with RASi treatment; and 1.45 (1.13-1.88), 1.90 (1.56-2.33), and 3.02 (2.01-4.54) for mild, moderate, and severe HF without RASi treatment.
Heart failure predicts the development of diabetes in a severity-dependent manner among patients with MI. Focus on increased predisposition to diabetes is warranted and needs further investigations.
心力衰竭（HF）与胰岛素抵抗增加有关，但 HF 对糖尿病发展的影响尚未得到充分研究。本研究旨在调查心肌梗死（MI）患者全国性队列中 HF 严重程度与发生糖尿病风险之间的关系。
从丹麦全国性登记处确定了 1997 年至 2006 年期间首次因 MI 出院且之前未接受过降糖药物（GLM）或袢利尿剂治疗的患者。HF 严重程度通过出院后袢利尿剂剂量确定。患者随访至首次开具 GLM 处方、死亡或 2006 年底。该队列包括 50874 名患者。其中 3006 例（6%）为轻度（袢利尿剂剂量≤40mg/天）、5383 例（11%）为中度（>40-120mg/天）、1127 例（2%）为重度（>120mg/天）HF。随访期间，2531 例（5%）患者发生糖尿病。HF 严重程度增加与糖尿病风险增加相关，但肾素-血管紧张素系统抑制剂（RASi）的使用减轻了这种风险（HF 组与 RASi 之间的交互作用 P 值<0.05）。与无 HF 相比，有 RASi 治疗的轻度、中度和重度 HF 患者发生糖尿病的调整后风险比（95%置信区间）分别为 1.34（1.11-1.63）、1.63（1.40-1.90）和 1.68（1.25-2.25）；无 RASi 治疗的轻度、中度和重度 HF 患者分别为 1.45（1.13-1.88）、1.90（1.56-2.33）和 3.02（2.01-4.54）。
MI 患者 HF 严重程度与糖尿病发生呈依赖性关系。需要进一步研究以关注增加患糖尿病的倾向。
