National Heart Centre Singapore, Singapore.
Changi General Hospital, Singapore.
Eur J Heart Fail. 2019 Mar;21(3):297-307. doi: 10.1002/ejhf.1358. Epub 2018 Dec 10.
To examine sex differences in clinical characteristics, echocardiographic features, quality of life and 1-year death or heart failure (HF) hospitalization outcomes in patients with/without diabetes mellitus (DM).
Utilizing the Asian Sudden Cardiac Death in HF (ASIAN-HF) registry, 5255 patients (mean age 59.6 ± 13.1, 78% men) with symptomatic HF with reduced ejection fraction (HFrEF) were stratified by DM status to address the research aims. Despite similar prevalence of DM between Asian men (43%) and women (42%), the odds of DM increased at lower body mass index in women vs. men (≥ 23 vs. ≥ 27.5 kg/m , P = 0.014). DM was more strongly related to chronic kidney disease in women vs. men [adjusted odds ratio (OR) 1.85, 95% confidence interval (CI) 1.33-2.57 vs. OR 1.32, 95% CI 1.11-1.56, P = 0.009]. Sex also modified the relationship between DM and left ventricular geometry (P = 0.003), whereby DM was associated with a more concentric left ventricular geometry in women than men. Women had lower quality of life than men (P < 0.001), in both DM and non-DM groups. DM was associated with worse composite outcomes at 1 year in women vs. men [hazard ratio (HR) 1.79, 95% CI 1.24-2.60 vs. HR 1.32, 95% CI 1.12-1.56; P = 0.005).
Asian women with HFrEF were more likely to have DM despite a lean body mass index, a greater burden of chronic kidney disease and more concentric left ventricular geometry, compared to men. Furthermore, DM confers worse quality of life, irrespective of sex, and a greater risk of adverse outcomes in women than men. These data underscore the need for sex-specific approaches to diabetes in patients with HF.
研究有/无糖尿病（DM）的患者在临床特征、超声心动图特征、生活质量以及 1 年死亡或心力衰竭（HF）住院结局方面的性别差异。
利用亚洲心力衰竭合并急性心源性猝死（ASIAN-HF）注册研究，按 DM 状态将 5255 例有症状射血分数降低的心力衰竭（HFrEF）患者（平均年龄 59.6±13.1 岁，78%为男性）分层，以解决研究目的。尽管亚洲男性（43%）和女性（42%）的 DM 患病率相似，但与男性相比，女性的 DM 发生几率随着较低的体重指数而增加（≥23 比≥27.5kg/m 2 ，P = 0.014）。DM 与女性慢性肾脏病的相关性比男性更强[校正比值比（OR）1.85，95%置信区间（CI）1.33-2.57 比 OR 1.32，95% CI 1.11-1.56，P = 0.009]。性别还改变了 DM 与左心室几何结构之间的关系（P = 0.003），即 DM 与女性比男性的更向心性左心室几何结构相关。与男性相比，女性无论是否患有 DM，生活质量均更差（P < 0.001）。在女性中，DM 与 1 年时更差的复合结局相关，而在男性中则不然[风险比（HR）1.79，95% CI 1.24-2.60 比 HR 1.32，95% CI 1.12-1.56；P = 0.005]。
与男性相比，亚洲女性 HFrEF 患者的 DM 发生几率尽管较低体重指数、更大的慢性肾脏病负担以及更向心性的左心室几何结构，但更有可能发生 DM。此外，DM 导致无论性别如何生活质量均更差，并且女性发生不良结局的风险高于男性。这些数据强调了在 HF 患者中需要针对不同性别采用特定于性别的糖尿病方法。
