Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
JACC Heart Fail. 2021 Aug;9(8):594-603. doi: 10.1016/j.jchf.2021.06.005.
This study assessed the association of diabetes duration with incident heart failure (HF).
Diabetes increases HF risk. However, the independent effect of diabetes duration on incident HF is unknown.
We included 9,734 participants (mean age 63 years, 58% women, 22% Black) at ARIC (Atherosclerosis Risk In Communities) Visit 4 (1996-1998) without HF or coronary heart disease. We calculated diabetes duration at Visit 4 (baseline), utilizing diabetes status at the first 4 ARIC visits spaced 3 years apart, and self-reported diagnosis date for those with diabetes diagnosed before Visit 1. We used Cox regression to estimate associations of diabetes duration with incident HF, accounting for intercurrent coronary heart disease and other risk factors. We performed analyses stratified by age (<65 years or ≥65 years), race, sex, and glycemic control (hemoglobin A [HbA] consistently <7%, vs HbA ≥7%), with tests for interaction.
Over 22.5 years of follow-up, there were 1,968 HF events. Compared to those without diabetes, HF risk rose with longer diabetes duration, with the highest risk among those with ≥15 y diabetes duration (HR: 2.82; 95% CI: 2.25-3.63). Each 5-year increase in diabetes duration was associated with a 17% (95% CI: 11-22) relative increase in HF risk. Similar results were observed across HF subtypes. The HF and diabetes duration associations were stronger among those aged <65 years, those with HbA ≥7%, those with a body mass index ≥30 kg/m, women, and Blacks (all P interactions <0.05).
Delaying diabetes onset may augment HF prevention efforts, and therapies to improve HF outcomes might target those with long diabetes duration.
本研究评估了糖尿病病程与心力衰竭（HF）事件的相关性。
糖尿病会增加 HF 的发病风险。然而，糖尿病病程对 HF 事件的独立影响尚不清楚。
我们纳入了 9734 名参与者（平均年龄 63 岁，58%为女性，22%为黑人），他们在 ARIC（社区动脉粥样硬化风险）研究的第 4 次访视（1996-1998 年）时没有 HF 或冠心病。我们在第 4 次访视（基线）时计算了糖尿病病程，利用了前 4 次 ARIC 访视间隔 3 年的糖尿病状态，并对那些在第 1 次访视前被诊断为糖尿病的人使用自我报告的诊断日期。我们使用 Cox 回归来估计糖尿病病程与 HF 事件的相关性，同时考虑到冠心病的发生和其他危险因素。我们根据年龄（<65 岁或≥65 岁）、种族、性别和血糖控制情况（血红蛋白 A1c [HbA]持续<7%，或 HbA≥7%）进行分层分析，并进行了交互作用检验。
在 22.5 年的随访期间，共发生了 1968 例 HF 事件。与没有糖尿病的人相比，HF 风险随着糖尿病病程的延长而升高，病程≥15 年的人风险最高（HR：2.82；95%CI：2.25-3.63）。糖尿病病程每增加 5 年，HF 风险相对增加 17%（95%CI：11-22）。在 HF 的不同亚型中也观察到了类似的结果。在年龄<65 岁、HbA≥7%、体重指数≥30kg/m、女性和黑人中，HF 和糖尿病病程之间的关联更强（所有 P 交互作用<0.05）。
延迟糖尿病发病可能会增强 HF 的预防效果，改善 HF 结局的治疗方法可能针对病程较长的糖尿病患者。
