Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA.
Ball State University, Muncie, IN, USA.
Int J Cardiol. 2022 Jan 1;346:30-34. doi: 10.1016/j.ijcard.2021.11.032. Epub 2021 Nov 17.
Evidence suggests diabetes mellitus is an independent risk factor for adverse cardiovascular events in patients with heart failure. As a result, we sought to compare mortality in patients with heart failure with reduced ejection fraction (HFrEF) with and without diabetes.
The Veteran Affairs Hospitals' databases were queried to identify all veterans diagnosed with HFrEF from 2007 to 2015. From the overall sample of 165,159 veterans, 41,120 patients with diabetes were matched by their propensity scores (without replacement) 1:1 to non-diabetic patients. To estimate the association between diabetes (Type 1 and 2) and overall mortality of HFrEF patients, a Cox proportional hazard model was used on the matched sample and controlled for patient characteristics for a mean follow up of 3.6 years (standard deviation ±2.3).
In a matched sample of 41,120 veterans with HFrEF with and without diabetes, those with diabetes and HFrEF were more often on guideline-directed medical therapy than those without diabetes. In the matched cohort, the mortality risk for patients with concurrent HFrEF and diabetes was 17.7% at 1 year and 74.3% at 5 years, whereas the mortality risk for those without diabetes was 15.3% at 1 year and 69.2% at 5 years. After controlling for patient characteristics such as age, sex, body mass index, heart rate, medical therapies, comorbidities, medications, low-density lipoproteins, high-density lipoproteins, we found that patients with diabetes compared to those without had a significantly increased risk of mortality (HR: 1.85, 95% CI: 1.77-1.92, p < 0.001).
Diabetic HFrEF patients have a higher risk of mortality than non-diabetic HFrEF patients despite controlling for medical therapies and comorbidities.
有证据表明，糖尿病是心力衰竭患者发生不良心血管事件的独立危险因素。因此，我们试图比较射血分数降低的心力衰竭（HFrEF）合并和不合并糖尿病患者的死亡率。
查询退伍军人事务部医院数据库，以确定 2007 年至 2015 年期间所有被诊断为 HFrEF 的退伍军人。在总体的 165159 名退伍军人样本中，通过倾向评分（无替换）将 41120 名糖尿病患者 1：1 匹配给非糖尿病患者。为了估计糖尿病（1 型和 2 型）与 HFrEF 患者总体死亡率之间的关系，对匹配样本使用 Cox 比例风险模型，并根据患者特征进行控制，平均随访时间为 3.6 年（标准差±2.3）。
在 HFrEF 合并和不合并糖尿病的 41120 名退伍军人匹配样本中，患有糖尿病和 HFrEF 的患者比没有糖尿病的患者更常接受指南指导的药物治疗。在匹配队列中，同时患有 HFrEF 和糖尿病的患者在 1 年时的死亡率风险为 17.7%，在 5 年时为 74.3%，而没有糖尿病的患者在 1 年时的死亡率风险为 15.3%，在 5 年时为 69.2%。在控制了患者特征（如年龄、性别、体重指数、心率、药物治疗、合并症、药物、低密度脂蛋白、高密度脂蛋白）后，我们发现与没有糖尿病的患者相比，患有糖尿病的患者死亡率显著增加（HR：1.85，95%CI：1.77-1.92，p<0.001）。
尽管控制了药物治疗和合并症，患有糖尿病的 HFrEF 患者的死亡率仍高于没有糖尿病的 HFrEF 患者。
