2 型糖尿病患者体成分测量的基线和纵向变化与心力衰竭和心肌梗死风险的关联：来自 LOOK AHEAD 试验的结果。
Association of Baseline and Longitudinal Changes in Body Composition Measures With Risk of Heart Failure and Myocardial Infarction in Type 2 Diabetes: Findings From the Look AHEAD Trial.
机构信息
Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (K.V.P., J.D.B., A.P.).
Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (K.V.P.).
出版信息
Circulation. 2020 Dec 22;142(25):2420-2430. doi: 10.1161/CIRCULATIONAHA.120.050941. Epub 2020 Nov 9.
BACKGROUND
Intentional weight loss is associated with lower risk of heart failure (HF) and atherosclerotic cardiovascular disease among patients with type 2 diabetes. However, the contribution of baseline measures and longitudinal changes in fat mass (FM), lean mass (LM), and waist circumference (WC) to the risk of HF and myocardial infarction (MI) in type 2 diabetes is not well established.
METHODS
Adults from the Look AHEAD trial (Action for Health in Diabetes) without prevalent HF were included. FM and LM were predicted using validated equations and compared with dual-energy x-ray absorptiometry measurements in a subgroup. Adjusted Cox models were used to evaluate the associations of baseline and longitudinal changes in FM, LM, and WC over 1- and 4-year follow-up with risk of overall HF, HF with preserved ejection fraction (EF; EF ≥50%), HF with reduced EF (EF <50%), and MI.
RESULTS
Among 5103 participants, there were 257 incident HF events over 12.4 years of follow-up. Predicted and measured FM/LM were highly correlated (=0.87-0.90; n=1369). FM and LM decreased over 4-year follow-up with greater declines in the intensive lifestyle intervention arm. In adjusted analysis, baseline body composition measures were not significantly associated with HF risk. Decline in FM and WC, but not LM, over 1 year were each significantly associated with lower risk of overall HF (adjusted hazard ratio per 10% decrease in FM, 0.80 [95% CI, 0.68-0.95]; adjusted hazard ratio per 10% decrease in WC, 0.77 [95% CI, 0.62-0.95]). Decline in FM was significantly associated with lower risk of both HF subtypes. In contrast, decline in WC was significantly associated with lower risk of HF with preserved EF but not HF with reduced EF. Similar patterns of association were observed for 4-year changes in body composition and HF risk. Longitudinal changes in body composition were not significantly associated with risk of MI.
CONCLUSIONS
In adults with type 2 diabetes, a lifestyle intervention is associated with significant loss of FM and LM. Declines in FM and WC, but not LM, were each significantly associated with lower risk of HF but not MI. Furthermore, decline in WC was significantly associated with lower risk of HF with preserved EF but not HF with reduced EF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00017953.
背景
在 2 型糖尿病患者中，有目的的减肥与心力衰竭（HF）和动脉粥样硬化性心血管疾病风险降低有关。然而，基线测量值和脂肪量（FM）、瘦体重（LM）和腰围（WC）的纵向变化对 2 型糖尿病 HF 和心肌梗死（MI）风险的贡献尚不清楚。
方法
纳入来自 LOOK AHEAD 试验（糖尿病中的健康行动）且无HF 既往史的成年人。使用经过验证的方程预测 FM 和 LM，并在亚组中与双能 X 射线吸收法测量值进行比较。使用调整后的 Cox 模型评估 1 年和 4 年随访期间 FM、LM 和 WC 的基线和纵向变化与整体 HF、射血分数保留的 HF（EF≥50%）、射血分数降低的 HF（EF<50%）和 MI 风险的相关性。
结果
在 5103 名参与者中，有 257 例 HF 事件发生在 12.4 年的随访期间。预测的和测量的 FM/LM 具有高度相关性（=0.87-0.90；n=1369）。在 4 年的随访中，FM 和 LM 逐渐减少，强化生活方式干预组的下降幅度更大。在调整分析中，基线身体成分测量值与 HF 风险无显著相关性。1 年内 FM 和 WC 的下降与整体 HF 风险降低显著相关（FM 每降低 10%，调整后的危险比为 0.80[95%CI，0.68-0.95]；WC 每降低 10%，调整后的危险比为 0.77[95%CI，0.62-0.95]）。FM 的下降与两种 HF 亚型的风险降低均显著相关。相比之下，WC 的下降与射血分数保留的 HF 风险降低显著相关，但与射血分数降低的 HF 风险降低无关。身体成分的 4 年变化与 HF 风险的关联模式相似。身体成分的纵向变化与 MI 风险无显著相关性。
结论
在 2 型糖尿病成人中，生活方式干预与 FM 和 LM 的显著丢失有关。FM 和 WC 的下降（但不是 LM）与 HF 风险降低显著相关，但与 MI 风险无关。此外，WC 的下降与射血分数保留的 HF 风险降低显著相关，但与射血分数降低的 HF 风险降低无关。
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