Wang Ying, Negishi Tomoko, Negishi Kazuaki, Marwick Thomas H
Menzies Research Institute Tasmania, 17 Liverpool Street, Hobart, TAS, Australia.
Menzies Research Institute Tasmania, 17 Liverpool Street, Hobart, TAS, Australia.
Diabetes Res Clin Pract. 2015 Apr;108(1):55-66. doi: 10.1016/j.diabres.2015.01.011. Epub 2015 Jan 20.
Heart failure (HF) is a major cause of mortality and disability in type 2 diabetes mellitus (T2DM). This study sought to improve the assessment of HF risk in patients with T2DM-a step that would be critical for effective HF screening.
A systematic literature search was performed on electronic databases including MEDLINE and EMBASE, using MeSH terms 'heart failure', 'risk factor', 'T2DM', 'cardiac dysfunction', 'stage B heart failure', 'incident heart failure', 'risk assessment', 'risk impact', 'risk score', 'predictor', 'prediction' and related free text terms. The search was limited to human studies in full-length publications in English language journal from 1946 to 2014. Univariable and multivariable relative risk (RR) and hazard ratio (HR) were obtained from each study.
Twenty-one studies (n=1111,569, including 507,637 subjects with T2DM) were included in this analysis with a follow-up ranging from 1 to 12 years. Associations between incident HF and risk variables described in ≥3 studies were reported. This association was greatest for insulin use (HR 2.48; 1.24-4.99), HbA1c 7.0-8.0% (2.41; 1.62-3.59), 5 years increase in age (1.47; 1.25-1.73), fasting glucose (1.28; 1.10-1.51 per standard deviation) and HbA1c (1.18; 1.14-1.23 each 1% increase). After adjustment for confounders, there were strong associations with coronary artery disease (1.77; 1.31, 2.39), HbA1c ≥ 10% (1.66; 1.45-1.89), insulin use (1.43; 1.14-1.79), HbA1c 9.0-10.0% (1.31; 1.14-1.50), fasting glucose (1.27; 1.10-1.47 per standard deviation) and 5 years increase in age (1.26; 1.13-1.40).
Among patients with T2DM, five common clinical variables are associated with significantly increased risk of incident HF.
心力衰竭（HF）是2型糖尿病（T2DM）患者死亡和残疾的主要原因。本研究旨在改善对T2DM患者HF风险的评估，这一步骤对于有效的HF筛查至关重要。
在包括MEDLINE和EMBASE在内的电子数据库上进行系统的文献检索，使用医学主题词“心力衰竭”、“危险因素”、“T2DM”、“心脏功能障碍”、“B期心力衰竭”、“新发心力衰竭”、“风险评估”、“风险影响”、“风险评分”、“预测因子”、“预测”以及相关的自由文本词。检索限于1946年至2014年在英文期刊上发表的全文人类研究。从每项研究中获取单变量和多变量相对风险（RR）及风险比（HR）。
本分析纳入了21项研究（n = 1111569，包括507637例T2DM患者），随访时间为1至12年。报告了≥3项研究中描述的新发HF与风险变量之间的关联。这种关联在胰岛素使用方面最为显著（HR 2.48；1.24 - 4.99）、糖化血红蛋白（HbA1c）为7.0 - 8.0%（2.41；1.62 - 3.59）、年龄增加5岁（1.47；1.25 - 1.73）、空腹血糖（每标准差1.28；1.10 - 1.51）以及HbA1c（每增加1%为1.18；1.14 - 1.23）时最为明显。在对混杂因素进行调整后，与冠状动脉疾病（1.77；1.31，2.39）、HbA1c≥10%（1.66；1.45 - 1.89）、胰岛素使用（1.43；1.14 - 1.79）、HbA1c为9.0 - 10.0%（1.31；1.14 - 1.50）、空腹血糖（每标准差1.27；1.10 - 1.47）以及年龄增加5岁（1.26；1.13 - 1.40）之间存在强关联。
在T2DM患者中，五个常见的临床变量与新发HF风险显著增加相关。
