Heart Failure Center, Heart Institute, Hadassah University Hospital, POB 12000, Jerusalem, Israel, IL-91120.
Eur J Heart Fail. 2014 Nov;16(11):1190-8. doi: 10.1002/ejhf.146. Epub 2014 Jul 31.
Glucose abnormalities are associated with heart failure (HF), are increasingly prevalent, and may have an impact on outcome. Our aim was to evaluate the effect of fasting glucose levels on clinical outcome in patients with HF.
Patients with a diagnosis of HF as coded at a health maintenance organization in Jerusalem, Israel were evaluated retrospectively. Impaired fasting glucose (IFG) was defined as fasting plasma glucose levels between 100 and 125 mg/dL. All patients were followed for cardiac-related hospitalizations and death. A total of 6067 HF patients were included. Mean follow-up was 487 days; mean age 75 ± 13 years; 48% of the patients (n = 2,942) had diabetes; and 11.9% (n = 722) had IFG. Overall survival during the follow-up was 82.5%. Cox regression analysis after adjustment for significant predictors including age, gender, ischaemic heart disease, hyperlipidaemia, hypertension, body mass index, glomerular filtration rate, serum urea, sodium, and haemoglobin levels demonstrated that patients with diabetes and IFG had a very similar outcome. Both were significant predictors of reduced survival compared with 'normal' glucose levels (fasting glucose levels between 92 and 99 mg/dL) [diabetes, hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.08-1.86, P = 0.01; IFG, HR 1.55, 95% CI 1.13-2.15, P < 0.01]. Diabetes and IFG were also predictors of increased cardiac-related hospitalizations (diabetes HR 1.31, 95% CI 1.16-1.48, P < 0.001; IFG, HR 1.17, 95% CI 1.00-1.35, P < 0.05).
Diabetes and IFG are common in patients with HF and have a similar effect on outcome including survival and cardiac hospitalizations. Glucose abnormalities including subclinical diabetes confer significant risk in patients with HF.
血糖异常与心力衰竭（HF）有关，其发病率越来越高，可能对预后有影响。本研究旨在评估空腹血糖水平对 HF 患者临床结局的影响。
本研究回顾性评估了以色列耶路撒冷一家健康维护组织中诊断为 HF 的患者。空腹血糖受损（IFG）定义为空腹血糖水平在 100-125mg/dL 之间。所有患者均随访心脏相关住院和死亡情况。共纳入 6067 例 HF 患者。平均随访时间为 487 天；平均年龄 75±13 岁；48%（n=2942）的患者患有糖尿病；11.9%（n=722）的患者有 IFG。随访期间的总体生存率为 82.5%。对包括年龄、性别、缺血性心脏病、高脂血症、高血压、体重指数、肾小球滤过率、血清尿素、钠和血红蛋白水平等显著预测因素进行调整后的 Cox 回归分析显示，糖尿病和 IFG 患者的预后非常相似。与“正常”血糖水平（92-99mg/dL 之间的空腹血糖水平）相比，这两种情况都是降低生存率的显著预测因素[糖尿病，风险比（HR）1.42，95%置信区间（CI）1.08-1.86，P=0.01；IFG，HR 1.55，95%CI 1.13-2.15，P<0.01]。糖尿病和 IFG 也是心脏相关住院的预测因素（糖尿病 HR 1.31，95%CI 1.16-1.48，P<0.001；IFG，HR 1.17，95%CI 1.00-1.35，P<0.05）。
糖尿病和 IFG 在 HF 患者中很常见，对包括生存率和心脏住院在内的预后有相似的影响。包括亚临床糖尿病在内的血糖异常会给 HF 患者带来显著风险。
