Chadalavada Sucharitha, Jensen Magnus T, Aung Nay, Cooper Jackie, Lekadir Karim, Munroe Patricia B, Petersen Steffen E
William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom.
Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom.
Front Cardiovasc Med. 2021 Apr 6;8:658726. doi: 10.3389/fcvm.2021.658726. eCollection 2021.
To investigate the effect of diabetes on mortality and incident heart failure (HF) according to sex, in the low risk population of UK Biobank. To evaluate potential contributing factors for any differences seen in HF end-point. The entire UK Biobank study population were included. Participants that withdrew consent or were diagnosed with diabetes after enrolment were excluded from the study. Univariate and multivariate cox regression models were used to assess endpoints of mortality and incident HF, with median follow-up periods of 9 years and 8 years respectively. A total of 493,167 participants were included, hereof 22,685 with diabetes (4.6%). Two thousand four hundred fifty four died and 1,223 were diagnosed or admitted with HF during the follow up periods of 9 and 8 years respectively. Overall, the mortality and HF risk were almost doubled in those with diabetes compared to those without diabetes (hazard ratio (HR) of 1.9 for both mortality and heart failure) in the UK Biobank population. Women with diabetes (both types) experience a 22% increased risk of HF compared to men (HR of 2.2 (95% CI: 1.9-2.5) vs. 1.8 (1.7-2.0) respectively). Women with type 1 diabetes (T1DM) were associated with 88% increased risk of HF compared to men (HR 4.7 (3.6-6.2) vs. 2.5 (2.0-3.0) respectively), while the risk of HF for type 2 diabetes (T2DM) was 17% higher in women compared to men (2.0 (1.7-2.3) vs. 1.7 (1.6-1.9) respectively). The increased risk of HF in women was independent of confounding factors. The findings were similar in a model with all-cause mortality as a competing risk. This interaction between sex, diabetes and outcome of HF is much more prominent for T1DM ( = 0.0001) than T2DM ( = 0.1). Women with diabetes, particularly those with T1DM, experience a greater increase in risk of heart failure compared to men with diabetes, which cannot be explained by the increased prevalence of cardiac risk factors in this cohort.
在英国生物银行的低风险人群中，根据性别调查糖尿病对死亡率和新发心力衰竭（HF）的影响。评估在HF终点观察到的任何差异的潜在促成因素。纳入了整个英国生物银行研究人群。撤回同意或在入组后被诊断出患有糖尿病的参与者被排除在研究之外。使用单变量和多变量Cox回归模型评估死亡率和新发HF的终点，中位随访期分别为9年和8年。总共纳入了493,167名参与者，其中22,685名患有糖尿病（4.6%）。在9年和8年的随访期内，分别有2454人死亡，1223人被诊断为HF或因HF入院。总体而言，在英国生物银行人群中，患有糖尿病的人相比未患糖尿病的人，死亡率和HF风险几乎增加了一倍（死亡率和心力衰竭的风险比（HR）均为1.9）。患有糖尿病（两种类型）的女性与男性相比，发生HF的风险增加了22%（HR分别为2.2（95%CI：1.9 - 2.5）和1.8（1.7 - 2.0））。与男性相比，患有1型糖尿病（T1DM）的女性发生HF的风险增加了88%（HR分别为4.7（3.6 - 6.2）和2.5（2.0 - 3.0）），而患有2型糖尿病（T2DM）的女性发生HF的风险比男性高17%（分别为2.0（1.7 - 2.3）和1.7（1.6 - 1.9））。女性HF风险的增加与混杂因素无关。在以全因死亡率作为竞争风险的模型中，研究结果相似。性别、糖尿病和HF结局之间的这种相互作用在T1DM（ = 0.0001）中比在T2DM（ = 0.1）中更为显著。与患有糖尿病的男性相比，患有糖尿病的女性，尤其是患有T1DM的女性，发生心力衰竭的风险增加更大，这无法用该队列中心脏危险因素患病率的增加来解释。
