心力衰竭患者人群中存在空腹血糖受损和胰岛素抵抗，这些患者射血分数降低或保留，但无糖尿病、超重或高血压。
Prediabetes and insulin resistance in a population of patients with heart failure and reduced or preserved ejection fraction but without diabetes, overweight or hypertension.
机构信息
Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam.
Science - Technology & External Relations Office, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam.
出版信息
Cardiovasc Diabetol. 2022 May 14;21(1):75. doi: 10.1186/s12933-022-01509-5.
BACKGROUND
The relationships between glucose abnormalities, insulin resistance (IR) and heart failure (HF) are unclear, especially regarding to the HF type, i.e., HF with reduced (HFrEF) or preserved (HFpEF) ejection fraction. Overweight, diabetes and hypertension are potential contributors to IR in persons with HF. This study aimed to evaluate the prevalence of prediabetes and IR in a population of Vietnamese patients with HFrEF or HFpEF but no overweight, diabetes or hypertension, in comparison with healthy controls, and the relation between prediabetes or IR and HF severity.
METHODS
We conducted a prospective cross-sectional observational study in 190 non-overweight normotensive HF patients (114 with HFrEF and 76 with HFpEF, 92.6% were ischemic HF, mean age was 70.1 years, mean BMI 19.7 kg/m) without diabetes (neither known diabetes nor newly diagnosed by OGTT) and 95 healthy individuals (controls). Prediabetes was defined using 2006 WHO criteria. Glucose and insulin levels were measured fasting and 2 h after glucose challenge. IR was assessed using HOMA-IR and several other indexes.
RESULTS
Compared to controls, HF patients had a higher prevalence of prediabetes (63.2% vs 22.1%) and IR (according to HOMA-IR, 55.3% vs 26.3%), higher HOMA-IR, insulin/glucose ratio after glucose and FIRI, and lower ISIT0 and ISIT120 (< 0.0001 for all comparisons), with no difference for body weight, waist circumference, blood pressure and lipid parameters. Prediabetes was more prevalent (69.3% vs 53.9%, p = 0.03) and HOMA-IR was higher (p < 0.0001) in patients with HFrEF than with HFpEF. Among both HFrEF and HFpEF patients, those with prediabetes or IR had a more severe HF (higher NYHA functional class and NT-proBNP levels, lower ejection fraction; p = 0.04-< 0.0001) than their normoglycemic or non-insulinresistant counterparts, with no difference for blood pressure and lipid parameters.
CONCLUSION
In non-diabetic non-overweight normotensive patients with HF, the prevalence of prediabetes is higher with some trend to more severe IR in those with HFrEF than in those with HFpEF. Both prediabetes and IR are associated with a more severe HF. The present data support HF as a culprit for IR. Intervention strategies should be proposed to HF patients with prediabetes aiming to reduce the risk of incident diabetes. Studies should be designed to test whether such strategies may translate into an improvement of further HF-related outcomes.
背景
葡萄糖异常、胰岛素抵抗（IR）和心力衰竭（HF）之间的关系尚不清楚，特别是对于 HF 类型，即射血分数降低（HFrEF）或保留（HFpEF）。超重、糖尿病和高血压是 HF 患者发生 IR 的潜在因素。本研究旨在评估越南人群中 HFrEF 或 HFpEF 但无超重、糖尿病或高血压患者中，与健康对照组相比，空腹血糖受损（IFG）和 IR 的患病率，并评估 IFG 或 IR 与 HF 严重程度的关系。
方法
我们进行了一项前瞻性、横断面观察性研究，纳入了 190 名非超重、血压正常的 HF 患者（HFrEF 患者 114 例，HFpEF 患者 76 例，92.6%为缺血性 HF，平均年龄 70.1 岁，平均 BMI 19.7kg/m²），无糖尿病（既无已知糖尿病，也无 OGTT 新诊断）和 95 名健康个体（对照组）。IFG 采用 2006 年 WHO 标准定义。空腹和葡萄糖负荷后 2 小时测量血糖和胰岛素水平。采用 HOMA-IR 和其他几种指标评估 IR。
结果
与对照组相比，HF 患者 IFG 患病率（63.2%比 22.1%）和 IR（根据 HOMA-IR，55.3%比 26.3%）更高，HOMA-IR、葡萄糖后胰岛素/血糖比值和 FIRI 更高，ISIT0 和 ISIT120 更低（所有比较均<0.0001），体重、腰围、血压和血脂参数无差异。HFrEF 患者 IFG 患病率（69.3%比 53.9%，p=0.03）和 HOMA-IR 更高（p<0.0001）。在 HFrEF 和 HFpEF 患者中，IFG 或 IR 患者的 HF 更严重（NYHA 心功能分级和 NT-proBNP 水平更高，射血分数更低；p=0.04-<0.0001），血压和血脂参数无差异。
结论
在非糖尿病、非超重、血压正常的 HF 患者中，IFG 患病率较高，HFrEF 患者的 IR 呈下降趋势，且比 HFpEF 患者更严重。IFG 和 IR 均与 HF 更严重相关。本研究数据支持 HF 是 IR 的罪魁祸首。应向 IFG 或 IR 患者提出干预策略，以降低发生糖尿病的风险。应设计研究以检验这些策略是否可改善 HF 相关的其他结局。
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