Zhao Wenhui, Katzmarzyk Peter T, Horswell Ronald, Wang Yujie, Johnson Jolene, Hu Gang
Pennington Biomedical Research Center (W.Z., P.T.K., R.H., Y.W., G.H.), Baton Rouge, Louisiana 70808; and Louisiana State University Health Baton Rouge (J.J.), Baton Rouge, Louisiana 70808.
J Clin Endocrinol Metab. 2014 Feb;99(2):E263-7. doi: 10.1210/jc.2013-3325. Epub 2013 Jan 1.
Diabetes is an independent risk factor for heart failure (HF); however, it is not known whether tight glycemic control can reduce the occurrence of HF among diabetic patients.
The aim of the study was to investigate the race-specific association of different levels of glycosylated hemoglobin (HbA1c) with the risk of HF among patients with diabetes.
DESIGN, SETTING, AND PARTICIPANTS: We prospectively investigated the race-specific association of different levels of HbA1c at baseline and during an average of 6.5 years of follow-up with incident HF risk among 17 181 African American and 12 446 white diabetic patients within the Louisiana State University Hospital System.
We measured incident HF until May 31, 2012.
During follow-up, 5089 HF incident cases were identified. The multivariable-adjusted hazard ratios of HF associated with different levels of HbA1c at baseline (<6.0% [reference group], 6.0-6.9%, 7.0-7.9%, 8.0-8.9%, 9.0-9.9%, and ≥10.0%,) were 1.00, 1.02 (95% confidence interval, 0.91-1.15), 1.21 (1.05-1.38), 1.29 (1.12-1.50), 1.37 (1.17-1.61), and 1.49 (1.31-1.69) (P trend < .001) for African American diabetic patients, and 1.00, 1.09 (0.96-1.22), 1.09 (0.95-1.26), 1.43 (1.22-1.67), 1.49 (1.25-1.77), and 1.61 (1.38-1.87) (P trend < .001) for white diabetic patients, respectively. This graded positive association was also present in diabetic patients with and without glucose-lowering agent treatment; in diabetic patients with different age, gender, and smoking status; and in incident HF defined as systolic HF (ejection fraction ≤ 40%) and HF with a preserved ejection fraction (ejection fraction > 40%).
The current study suggests a graded positive association of HbA1c with the risk of HF among both African American and white patients with diabetes.
糖尿病是心力衰竭（HF）的独立危险因素；然而，严格血糖控制是否能降低糖尿病患者HF的发生率尚不清楚。
本研究旨在调查糖尿病患者中不同糖化血红蛋白（HbA1c）水平与HF风险的种族特异性关联。
设计、地点和参与者：我们前瞻性地研究了路易斯安那州立大学医院系统内17181名非裔美国糖尿病患者和12446名白人糖尿病患者在基线时以及平均6.5年随访期间不同HbA1c水平与HF发病风险的种族特异性关联。
我们测量了截至2012年5月31日的HF发病情况。
随访期间，共确定了5089例HF发病病例。非裔美国糖尿病患者中，与基线时不同HbA1c水平（<6.0%[参照组]、6.0 - 6.9%、7.0 - 7.9%、8.0 - 8.9%、9.0 - 9.9%和≥10.0%）相关的HF多变量调整风险比分别为1.00、1.02（95%置信区间，0.91 - 1.15）、1.21（1.05 - 1.38）、1.29（1.12 - 1.50）、1.3
