Division of Cardiology, Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, 14-002, Chicago, IL, 60611, USA.
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Cardiovasc Diabetol. 2021 Mar 22;20(1):66. doi: 10.1186/s12933-021-01265-y.
Given the rising prevalence of dysglycemia and disparities in heart failure (HF) burden, we determined race- and sex-specific lifetime risk of HF across the spectrum of fasting plasma glucose (FPG).
Individual-level data from adults without baseline HF was pooled from 6 population-based cohorts. Modified Kaplan-Meier analysis, Cox models adjusted for the competing risk of death, and Irwin's restricted mean were used to estimate the lifetime risk, adjusted hazard ratio (aHR), and years lived free from HF in middle-aged (40-59 years) and older (60-79 years) adults with FPG < 100 mg/dL, prediabetes (FPG 100-125 mg/dL) and diabetes (FPG ≥ 126 mg/dL or on antihyperglycemic agents) across race-sex groups.
In 40,117 participants with 638,910 person-years of follow-up, 4846 cases of incident HF occurred. The lifetime risk of HF was significantly higher among middle-aged White adults and Black women with prediabetes (range: 6.1% [95% CI 4.8%, 7.4%] to 10.8% [95% CI 8.3%, 13.4%]) compared with normoglycemic adults (range: 3.5% [95% CI 3.0%, 4.1%] to 6.5% [95% CI 4.9%, 8.1%]). Middle-aged Black women with diabetes had the highest lifetime risk (32.4% [95% CI 26.0%, 38.7%]) and aHR (4.0 [95% CI 3.0, 5.4]) for HF across race-sex groups. Middle-aged adults with prediabetes and diabetes lived on average 0.9-1.6 and 4.1-6.0 fewer years free from HF, respectively. Findings were similar in older adults except older Black women with prediabetes did not have a higher lifetime risk of HF.
Prediabetes was associated with higher lifetime risk of HF in middle-aged White adults and Black women, with the association attenuating in older Black women. Black women with diabetes had the highest lifetime risk of HF compared with other race-sex groups.
鉴于糖尿病前期和心力衰竭负担的差异日益增大，我们确定了空腹血糖（FPG）谱中各种情况下的心力衰竭终生风险的种族和性别特异性。
从 6 个人群为基础的队列中汇集了没有基线心力衰竭的成年人的个体水平数据。采用改良的 Kaplan-Meier 分析、校正死亡竞争风险的 Cox 模型和 Irwin 受限均值，以估计 FPG<100mg/dL、糖尿病前期（FPG 100-125mg/dL）和糖尿病（FPG≥126mg/dL 或使用抗高血糖药物）的中年（40-59 岁）和老年（60-79 岁）成年人中，FPG<100mg/dL、糖尿病前期（FPG 100-125mg/dL）和糖尿病（FPG≥126mg/dL 或使用抗高血糖药物）的种族-性别组中，心力衰竭的终生风险、校正后的危险比（aHR）和无心力衰竭的年数。
在 40117 名参与者中，随访了 638910 人年，发生了 4846 例心力衰竭事件。与正常血糖成年人相比，中年白人成年人和黑人女性中的糖尿病前期患者发生心力衰竭的终生风险显著更高（范围：6.1%[95%CI 4.8%，7.4%]至 10.8%[95%CI 8.3%，13.4%]）（范围：3.5%[95%CI 3.0%，4.1%]至 6.5%[95%CI 4.9%，8.1%]）。中年黑人女性糖尿病患者的心力衰竭终生风险最高（32.4%[95%CI 26.0%，38.7%]）和 aHR（4.0[95%CI 3.0，5.4]）最高，在所有种族-性别组中。患有糖尿病前期和糖尿病的中年成年人平均分别减少了 0.9-1.6 年和 4.1-6.0 年的无心力衰竭时间。老年人的结果相似，但老年黑人女性的糖尿病前期与心力衰竭的终生风险没有更高。
糖尿病前期与中年白人成年人和黑人女性的心力衰竭终生风险增加有关，而在老年黑人女性中，这种关联减弱。与其他种族-性别群体相比，黑人女性糖尿病患者的心力衰竭终生风险最高。
