Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Division of Cardiology, Department of Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
J Gerontol A Biol Sci Med Sci. 2022 Dec 29;77(12):2489-2497. doi: 10.1093/gerona/glac094.
Individuals with diabetes have a high frailty burden and increased risk of heart failure (HF). In this study, we evaluated the association of baseline and longitudinal changes in frailty with risk of HF and its subtypes: HF with preserved ejection fraction (HFpEF), and HF with reduced ejection fraction (HFrEF).
Participants (age: 45-76 years) of the Look AHEAD trial without prevalent HF were included. The frailty index (FI) was used to assess frailty burden using a 35-variable deficit model. The association between baseline and longitudinal changes (1- and 4-year follow-up) in FI with risk of overall HF, HFpEF (ejection fraction [EF] ≥ 50%), and HFrEF (EF < 50%) independent of other risk factors and cardiorespiratory fitness was assessed using adjusted Cox models.
The study included 5 100 participants with type 2 diabetes mellitus, of which 257 developed HF. In adjusted analysis, higher frailty burden was significantly associated with a greater risk of overall HF. Among HF subtypes, higher baseline FI was significantly associated with risk of HFpEF (hazard ratio [HR] [95% CI] per 1-SD higher FI: 1.37 [1.15-1.63]) but not HFrEF (HR [95% CI]: 1.19 [0.96-1.46]) after adjustment for potential confounders, including traditional HF risk factors. Among participants with repeat measures of FI at 1- and 4-year follow-up, an increase in frailty burden was associated with a higher risk of HFpEF (HR [95% CI] per 1-SD increase in FI at 4 years: 1.78 [1.35-2.34]) but not HFrEF after adjustment for other confounders.
Among individuals with type 2 diabetes mellitus, higher baseline frailty and worsening frailty burden over time were independently associated with higher risk of HF, particularly HFpEF after adjustment for other confounders.
患有糖尿病的个体有较高的脆弱性负担和心力衰竭（HF）风险增加。在这项研究中，我们评估了基线和纵向虚弱变化与 HF 及其亚型（HFpEF，射血分数保留的心力衰竭和 HFrEF，射血分数降低的心力衰竭）风险之间的关联。
该研究纳入了没有先前 HF 的 LOOK AHEAD 试验的参与者。使用 35 变量缺陷模型的虚弱指数（FI）评估虚弱负担。使用调整后的 Cox 模型评估 FI 的基线和纵向变化（1 年和 4 年随访）与整体 HF、HFpEF（射血分数[EF]≥50%）和 HFrEF（EF<50%）风险之间的关联，独立于其他危险因素和心肺适应能力。
该研究纳入了 5100 名 2 型糖尿病患者，其中 257 名发生 HF。在调整分析中，较高的虚弱负担与整体 HF 风险显著相关。在 HF 亚型中，较高的基线 FI 与 HFpEF 风险显著相关（每增加 1-SD FI 的 HR[95%CI]：1.37[1.15-1.63]），但与 HFrEF 无关（HR[95%CI]：1.19[0.96-1.46]），调整了潜在混杂因素，包括传统的 HF 危险因素。在有 FI 1 年和 4 年随访重复测量的参与者中，虚弱负担的增加与 HFpEF 风险增加相关（FI 每年增加 1-SD 的 HR[95%CI]：1.78[1.35-2.34]），但在调整其他混杂因素后与 HFrEF 无关。
在 2 型糖尿病患者中，较高的基线脆弱性和随时间推移的脆弱性负担增加与 HF 风险增加独立相关，尤其是在调整其他混杂因素后与 HFpEF 相关。
