Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Eur J Heart Fail. 2013 Feb;15(2):185-93. doi: 10.1093/eurjhf/hfs156. Epub 2012 Oct 25.
Clinical trials to date have not provided definitive evidence regarding the effects of glucose lowering on the incidence of congestive heart failure (CHF). We synthesized available prospective epidemiological data on the association between glycaemia measured by haemoglobin A(1c) (HbA(1c)) and incident CHF in individuals with diabetes.
We searched electronic databases and reference lists of selected articles for relevant prospective epidemiological studies. We abstracted data from relevant studies using standardized forms and obtained additional data from investigators when required. We pooled study-specific relative risk estimates using random-effects model meta-analysis. Of the 1044 citations identified, we included 10 studies comprising 178 929 participants with diabetes and 14 176 incident CHF cases. Five studies included only patients with type 2 diabetes, four studies had predominantly patients with type 2 diabetes, and one study included only patients with type 1 diabetes. All studies except one showed an increased risk of CHF with higher HbA(1c). The overall adjusted risk ratio (RR) for CHF was 1.15 [95% confidence interval (CI) 1.10-1.21] for each percentage point higher HbA(1c). There was substantial heterogeneity across the 10 studies (I(2): 83%; 95% CI 69-91%; P < 0.001) not explained by available study-level characteristics such as study design or average HbA(1c) level. In seven studies reporting RRs with more than one degree of adjustment, the association was minimally altered after adjustment for several cardiovascular risk factors.
In observational studies of individuals with diabetes, a higher HbA(1c) level was associated with a significantly increased incidence of CHF.
迄今为止的临床试验并未提供明确的证据表明降低血糖对充血性心力衰竭（CHF）的发生率有影响。我们综合了现有的关于通过糖化血红蛋白（HbA1c）测量的血糖水平与糖尿病患者发生 CHF 的前瞻性流行病学数据。
我们在电子数据库中进行了检索，并查阅了选定文章的参考文献列表，以寻找相关的前瞻性流行病学研究。我们使用标准化表格从相关研究中提取数据，并在需要时从研究人员那里获取额外的数据。我们使用随机效应模型荟萃分析汇总了研究特异性的相对风险估计值。在确定的 1044 条引用中，我们纳入了 10 项研究，共纳入了 178929 名糖尿病患者和 14176 例 CHF 事件。其中 5 项研究仅包括 2 型糖尿病患者，4 项研究以 2 型糖尿病患者为主，1 项研究仅包括 1 型糖尿病患者。除一项研究外，其余所有研究均显示 HbA1c 升高与 CHF 风险增加相关。每增加一个百分点的 HbA1c，CHF 的总体校正风险比（RR）为 1.15（95%置信区间 1.10-1.21）。这 10 项研究之间存在很大的异质性（I²：83%；95%置信区间 69-91%；P<0.001），无法用可用的研究水平特征（如研究设计或平均 HbA1c 水平）来解释。在 7 项报告 RR 且调整超过一个程度的研究中，在调整了几个心血管危险因素后，相关性几乎没有改变。
在对糖尿病患者的观察性研究中，HbA1c 水平升高与 CHF 的发生率显著增加相关。
