Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Division of Cardiology, Department of Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
J Am Coll Cardiol. 2022 Jun 14;79(23):2285-2293. doi: 10.1016/j.jacc.2022.03.378.
The influence of diabetes on progression from preclinical heart failure (HF) stages to overt HF is poorly understood.
The purpose of this study was to characterize the influence of diabetes on the progression from preclinical HF stages (A or B based on the 2021 Universal Definition) to overt HF.
We included 4,774 adults with preclinical HF (stage A [n = 1,551] or B [n = 3,223]) who attended the ARIC (Atherosclerosis Risk In Communities) study Visit 5 (2011-2013). Within each stage (A or B), we assessed the associations of diabetes and glycemic control (hemoglobin A [HbA] <7% vs ≥7%) with progression to HF, and of cross-categories of HF stages (A vs B), diabetes, and glycemic control with incident HF.
Among the participants (mean age 75.4 years, 58% women, 20% Black), there were 470 HF events during 8.6 years of follow-up. Stage B participants with HbA ≥7% experienced clinical HF at a younger age than those with controlled diabetes or without diabetes (mean age 80 years vs 83 years vs 82 years; P < 0.001). HbA ≥7% was more strongly associated with HF in stage B (HR: 1.83; 95% CI: 1.33-2.51) compared with stage A (HR: 1.52; 95% CI: 0.53-4.38). In cross-categories of preclinical HF stage and HbA, participants with stage B and HbA ≥7% had increased risk of HF progression compared with stage A without diabetes (HR: 7.56; 95% CI: 4.68-12.20).
Among older adults with preclinical HF stages, uncontrolled diabetes was associated with substantial risk of HF progression. Our results suggest that targeting diabetes early in the HF process is critical.
糖尿病对从临床前心力衰竭（HF）阶段进展为显性 HF 的影响知之甚少。
本研究旨在描述糖尿病对从临床前 HF 阶段（基于 2021 年通用定义的 A 或 B 期）进展为显性 HF 的影响。
我们纳入了 4774 名患有临床前 HF（A 期 [n=1551] 或 B 期 [n=3223]）的成年人，他们参加了 ARIC（社区动脉粥样硬化风险）研究第五次随访（2011-2013 年）。在每个阶段（A 或 B）内，我们评估了糖尿病和血糖控制（血红蛋白 A [HbA] <7%与≥7%）与 HF 进展的关系，以及 HF 阶段（A 与 B）、糖尿病和血糖控制的交叉类别与 HF 事件的关系。
在参与者中（平均年龄 75.4 岁，58%为女性，20%为黑人），在 8.6 年的随访期间发生了 470 例 HF 事件。HbA≥7%的 B 期患者比控制良好的糖尿病患者或无糖尿病患者更早出现临床 HF（平均年龄 80 岁比 83 岁比 82 岁；P<0.001）。HbA≥7%与 B 期 HF 的相关性更强（HR：1.83；95%CI：1.33-2.51），而与 A 期 HF（HR：1.52；95%CI：0.53-4.38）相比则较弱。在临床前 HF 阶段和 HbA 的交叉类别中，与无糖尿病的 A 期患者相比，B 期和 HbA≥7%的患者 HF 进展的风险增加（HR：7.56；95%CI：4.68-12.20）。
在患有临床前 HF 阶段的老年人中，未控制的糖尿病与 HF 进展的风险显著增加相关。我们的结果表明，在 HF 进程早期靶向糖尿病至关重要。
