Department of Cardiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Int J Cardiol. 2018 Jan 1;250:188-194. doi: 10.1016/j.ijcard.2017.10.035. Epub 2017 Oct 16.
There is a strong reciprocal relationship between heart failure (HF) and diabetes mellitus (DM). Shared pathophysiological mechanisms might be a possible explanation. Therefore, we hypothesised that biomarkers linked to HF would also predict new-onset type 2 DM in the general population.
We utilized the Prevention of Vascular and Renal End-stage Disease (PREVEND) cohort (mean age 48.9years, 51% female) to study the relationship between HF and DM in 7953 participants free of baseline HF and DM. Multiple HF-related, inflammation-related and renal function-related biomarkers were evaluated regarding their predictive utility in new-onset DM. Incidence of DM in participants who developed HF was 11.8%, versus 5.4% in those who had not developed HF (p<0.001). Incidence of HF in participants who developed DM was 8.5%, versus 3.8% in those who had not developed DM (p<0.001). Classical HF biomarkers, NT-proBNP and hs-TnT were not associated with an increased risk for new-onset DM. However, inflammatory biomarkers hs-CRP [hazard ratio (HR) 1.16, (95% CI 1.05 to 1.29), p=0.005], procalcitonin [HR 1.34, (95% CI 1.07 to 1.69), p=0.012] and PAI-1 [HR 1.55, (95% CI 1.37 to 1.75), p<0.001] remained significantly associated with new-onset DM, even after multivariable adjustment for established predictors of DM.
Although HF and DM have a strong correlation with each other, systemic biomarkers that predict HF do not have a predictive value in new-onset DM. This suggests that other, indirect, pathophysiological mechanisms related to inflammation may explain their strong relation.
心力衰竭（HF）和糖尿病（DM）之间存在着强烈的相互关系。共同的病理生理机制可能是一个可能的解释。因此，我们假设与 HF 相关的生物标志物也可以预测普通人群中新发的 2 型糖尿病。
我们利用预防血管和肾脏终末期疾病（PREVEND）队列（平均年龄 48.9 岁，51%为女性），在 7953 名无基线 HF 和 DM 的参与者中研究 HF 和 DM 之间的关系。评估了多种与 HF 相关、与炎症相关和与肾功能相关的生物标志物，以研究其在新发 DM 中的预测效用。在发生 HF 的参与者中，DM 的发生率为 11.8%，而未发生 HF 的参与者为 5.4%（p<0.001）。在发生 DM 的参与者中，HF 的发生率为 8.5%，而未发生 DM 的参与者为 3.8%（p<0.001）。经典的 HF 生物标志物 NT-proBNP 和 hs-TnT 与新发 DM 的风险增加无关。然而，炎症生物标志物 hs-CRP [危险比（HR）1.16，（95%置信区间 1.05 至 1.29），p=0.005]、降钙素原 [HR 1.34，（95%置信区间 1.07 至 1.69），p=0.012]和 PAI-1 [HR 1.55，（95%置信区间 1.37 至 1.75），p<0.001] 与新发 DM 仍显著相关，即使在多变量调整 DM 的既定预测因素后也是如此。
尽管 HF 和 DM 之间有很强的相关性，但预测 HF 的系统生物标志物在新发 DM 中没有预测价值。这表明，其他与炎症相关的间接病理生理机制可能解释了它们之间的强烈关系。
