Serviço de Endocrinologia, Centro Hospitalar de Trás-os-Montes e Alto Douro, Avenida da Noruega, 4202-451, Lordelo, Vila Real, Portugal.
Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal.
Acta Diabetol. 2018 Mar;55(3):271-278. doi: 10.1007/s00592-017-1092-9. Epub 2018 Jan 8.
Increasing age is an established prognostic determinant in chronic heart failure (HF). Diabetes often complicates HF in its course and appears to worsen HF prognosis. A differential impact of diabetes depending on patients' age was not yet studied. We evaluated the impact of diabetes in the mortality of HF patients according to their age.
We studied a cohort of chronic ambulatory HF patients prospectively recruited. Patients were on optimized evidence-based therapy, and they were excluded if on renal replacement therapy or if they had any therapy modification or hospitalizations in the previous 2 months. Patients were followed for up to 5 years; all-cause mortality was analyzed. Mortality predictors were assessed using a Cox regression. Analysis was stratified according to patient's age: cutoff 75 years. Multivariate models were built. Interaction between diabetes and age was formally tested.
We studied 283 chronic HF patients; mean age was 69 years and 70.3% were male; 58.0% had severe systolic dysfunction; 105 (37.1%) were diabetic. In patients with less than 75 years, the coexistence of diabetes predicted a multivariate adjusted 1.98 (95% CI 1.13-3.46) 5-year death risk while in older patients (≥ 75 years) no significant association was reported. Age interacted with the prognostic impact of diabetes, p for interaction = 0.04.
The prognostic impact of diabetes in chronic HF depends on patient's age. In patients < 75 years, the coexistence of diabetes predicts an almost double risk of 5-year mortality; no such association exists in patients with 75 years or above. Diabetes predicts mortality only in younger HF patients.
年龄的增长是慢性心力衰竭（HF）的既定预后决定因素。糖尿病在 HF 病程中经常并发，并似乎使 HF 预后恶化。糖尿病对患者年龄的影响尚待研究。我们评估了糖尿病对 HF 患者死亡率的影响，根据患者的年龄进行分析。
我们前瞻性地研究了一个慢性门诊 HF 患者队列。患者接受了优化的循证治疗，如果患者正在接受肾脏替代治疗，或在过去 2 个月内进行了任何治疗调整或住院治疗，则将其排除在外。患者随访时间长达 5 年；分析全因死亡率。使用 Cox 回归评估死亡率预测因素。根据患者的年龄进行分层分析：截断值为 75 岁。建立多变量模型。正式检验糖尿病与年龄之间的交互作用。
我们研究了 283 例慢性 HF 患者；平均年龄为 69 岁，70.3%为男性；58.0%有严重的收缩功能障碍；105 例（37.1%）为糖尿病患者。在年龄小于 75 岁的患者中，糖尿病的共存预测了多变量调整后的 5 年死亡风险增加 1.98（95%CI 1.13-3.46），而在年龄较大的患者（≥75 岁）中未报告显著相关性。年龄与糖尿病预后影响之间存在交互作用，p 值为 0.04。
糖尿病对慢性 HF 的预后影响取决于患者的年龄。在年龄<75 岁的患者中，糖尿病的共存预测 5 年死亡率增加近两倍；在 75 岁或以上的患者中不存在这种相关性。糖尿病仅在年轻的 HF 患者中预测死亡率。
