Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Lancet. 2011 Jul 9;378(9786):140-6. doi: 10.1016/S0140-6736(11)60471-6. Epub 2011 Jun 24.
Poor glycaemic control is associated with microvascular and macrovascular complications in type 1 diabetes, but whether glycaemic control is associated with heart failure in such patients is not known. We aimed to assess this association in a large cohort of patients with type 1 diabetes identified from the Swedish national diabetes registry.
We identified all patients (aged ≥18 years) with type 1 diabetes and no known heart failure who were registered in the national diabetes registry between January, 1998, and December, 2003. These patients were followed up until hospital admission for heart failure, death, or end of follow-up on Dec 31, 2009. We calculated incidence categorised by glycated haemoglobin A(1c) (HbA(1c)) values, and we assessed the association between patients' characteristics, including HbA(1c), and heart failure.
In a cohort of 20,985 patients with mean age of 38·6 years (SD 13·3) at baseline, 635 patients (3%) were admitted to hospital with a primary or secondary diagnosis of heart failure during a median follow-up of 9·0 years (IQR 7·3-11·0), with an incidence of 3·38 events per 1000 patient-years (95% CI 3·12-3·65). Incidence increased monotonically with HbA(1c), with a range of 1·42-5·20 per 1000 patient-years between patients in the lowest (<6·5%) and highest (≥10·5%) categories of HbA(1c). In a Cox regression analysis, with adjustment for age, sex, duration of diabetes, cardiovascular risk factors, and baseline or intervening acute myocardial infarction and other comorbidities, the hazard ratio for development of heart failure was 3·98 (95% CI 2·23-7·14) in patients with HbA(1c) of 10·5% or higher compared with a reference group of patients with HbA(1c) of less than 6·5%. Risk of heart failure increased with age and duration of diabetes. Other modifiable factors associated with increased risk of heart failure were smoking, high systolic blood pressure, and raised body-mass index. In a subgroup of 18,281 patients (87%) with data for blood lipids, higher HDL cholesterol was associated with lower risk of heart failure, but there was no association with LDL cholesterol.
The positive association between HbA(1c) and risk of heart failure in fairly young patients with type 1 diabetes indicates a potential for prevention of heart failure with improved glycaemic control.
AstraZeneca, Novo Nordisk Scandinavia, Swedish Heart and Lung Foundation, and Swedish Research Council.
1 型糖尿病患者血糖控制不佳与微血管和大血管并发症有关，但血糖控制是否与此类患者的心力衰竭有关尚不清楚。我们旨在通过瑞典国家糖尿病登记处的大型 1 型糖尿病患者队列评估这种关联。
我们确定了所有（年龄≥18 岁）在 1998 年 1 月至 2003 年 12 月期间在国家糖尿病登记处登记且无已知心力衰竭的 1 型糖尿病患者。这些患者随访至因心力衰竭、死亡或 2009 年 12 月 31 日随访结束而住院。我们根据糖化血红蛋白 A1c（HbA1c）值计算发病率，并评估患者特征（包括 HbA1c）与心力衰竭之间的关联。
在基线时平均年龄为 38.6 岁（SD 13.3）的 20985 名患者队列中，中位随访 9.0 年（IQR 7.3-11.0）期间，635 名患者（3%）因原发性或继发性心力衰竭住院，每 1000 名患者年的发病率为 3.38 例（95%CI 3.12-3.65）。发病率随 HbA1c 单调增加，HbA1c 最低（<6.5%）和最高（≥10.5%）类别之间的患者每年每 1000 名患者的发病率范围为 1.42-5.20。在调整年龄、性别、糖尿病病程、心血管危险因素以及基线或介入性急性心肌梗死和其他合并症后，HbA1c 为 10.5%或更高的患者与 HbA1c 小于 6.5%的参考组相比，心力衰竭发生的风险比为 3.98（95%CI 2.23-7.14）。心力衰竭的风险随年龄和糖尿病病程的增加而增加。与心力衰竭风险增加相关的其他可改变因素包括吸烟、高收缩压和升高的体重指数。在有血脂数据的 18281 名患者（87%）的亚组中，较高的高密度脂蛋白胆固醇与心力衰竭风险降低相关，但与低密度脂蛋白胆固醇无关。
在相当年轻的 1 型糖尿病患者中，HbA1c 与心力衰竭风险之间的正相关表明通过改善血糖控制有可能预防心力衰竭。
阿斯利康、诺和诺德、瑞典心脏和肺基金会以及瑞典研究理事会。
