微血管负担与 1 型或 2 型糖尿病中老年患者心力衰竭的发生。
Microvascular Burden and Incident Heart Failure Among Middle-Aged and Older Adults With Type 1 or Type 2 Diabetes.
机构信息
Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, China.
Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China.
出版信息
Diabetes Care. 2022 Dec 1;45(12):2999-3006. doi: 10.2337/dc22-0177.
OBJECTIVE
To examine the association between microvascular disease (MVD) and risk of heart failure (HF) among individuals with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM).
RESEARCH DESIGN AND METHODS
We included 1,713 and 28,624 participants with T1DM and T2DM, respectively, from the UK Biobank who were free of HF during enrollment. MVD burden reflected by the presence of retinopathy, peripheral neuropathy, and chronic kidney disease (CKD) at baseline was prospectively evaluated for the association with incidence of HF. Hazard ratios (HRs) and 95% CIs of HF were estimated by Cox regression models adjusted for multiple traditional risk factors.
RESULTS
There were 145 and 2,515 incident cases of HF recorded among participants with T1DM and T2DM, respectively, during a median follow-up of 11.5 years. The association between the number of MVD and HF was stronger among participants with T1DM than among those with T2DM (P for interaction <0.001). Compared with participants with no MVD, those with all three MVD had an adjusted HR (95% CI) of 11.37 (5.62, 22.99) in T1DM and 3.66 (2.74, 4.88) in T2DM. In T1DM, HRs (CIs) were 2.69 (1.75, 4.14) for retinopathy, 2.11 (1.38, 3.23) for peripheral neuropathy, and 2.21 (1.53, 3.18) for CKD. The corresponding estimates in T2DM were 1.24 (1.13, 1.36), 1.63 (1.36, 1.96), and 1.73 (1.59, 1.89), respectively.
CONCLUSIONS
While a heavier burden of MVD was associated with excess risk of HF both in T1DM and T2DM, the association was evidently more pronounced in T1DM.
目的
研究微血管疾病（MVD）与 1 型糖尿病（T1DM）或 2 型糖尿病（T2DM）患者心力衰竭（HF）风险之间的关系。
研究设计与方法
我们纳入了分别来自英国生物库的 1713 名和 28624 名 T1DM 和 T2DM 患者，这些患者在入组时均无 HF。在基线时存在视网膜病变、周围神经病变和慢性肾脏病（CKD）的 MVD 负担被前瞻性评估与 HF 发生率的相关性。通过 Cox 回归模型，对经过多种传统危险因素调整后的 HF 的风险比（HR）和 95%置信区间（CI）进行了估计。
结果
在中位随访 11.5 年后，T1DM 和 T2DM 患者中分别有 145 例和 2515 例 HF 新发病例。与 T2DM 患者相比，T1DM 患者的 MVD 数量与 HF 之间的相关性更强（P 交互<0.001）。与无 MVD 的患者相比，T1DM 患者同时存在三种 MVD 的患者校正后的 HR（95%CI）为 11.37（5.62，22.99），T2DM 患者为 3.66（2.74，4.88）。在 T1DM 中，视网膜病变的 HR（CI）为 2.69（1.75，4.14），周围神经病变为 2.11（1.38，3.23），CKD 为 2.21（1.53，3.18）。在 T2DM 中，相应的估计值分别为 1.24（1.13，1.36）、1.63（1.36，1.96）和 1.73（1.59，1.89）。
结论
尽管在 T1DM 和 T2DM 中，MVD 负担的加重与 HF 风险的增加相关，但在 T1DM 中，这种关联显然更为明显。
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