The Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL.
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL.
J Card Fail. 2023 Mar;29(3):246-254. doi: 10.1016/j.cardfail.2022.10.426. Epub 2022 Nov 4.
Individuals with prediabetes and diabetes are at increased risk of atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF). Whether ASCVD or HF is more likely to occur first in these populations within different race-sex groups is unknown.
To determine the competing risk for the first cardiovascular event by subtype in Black and white men and women with prediabetes and diabetes.
Individual-level data from adults without ASCVD or HF were pooled from 6 population-based cohorts. We estimated the competing cumulative incidences of ASCVD, HF and noncardiovascular death as the first event in middle-aged (40-59 years) and older (60-79 years) adults, stratified by race and sex, with normal fasting plasma glucose (FPG < 100 mg/dL), prediabetes (FPG 100-125 mg/dL) and diabetes (FPG ≥ 126 mg/dL or on antihyperglycemic agents) at baseline. Within each race-sex group, we estimated risk the adjusted hazard ratio of ASCVD, HF and noncardiovascular death in adults with prediabetes and diabetes relative to adults with normoglycemia after adjusting for cardiovascular risk factors.
In 40,117 participants with 638,910 person-years of follow-up, 5781 cases of incident ASCVD and 3179 cases of incident HF occurred. In middle-aged adults with diabetes, competing cumulative incidence of ASCVD as a first event was higher than HF in white men (35.4% vs 11.6%), Black men (31.6% vs 15.1%) and white women (24.3% vs 17.2%) but not in Black women (26.4% vs 28.4%). Within each group, the adjusted hazard ratio of ASCVD and HF was significantly higher in adults with diabetes than in adults with normal FPG levels. Findings were largely similar in middle-aged adults with prediabetes and older adults with prediabetes or diabetes.
Black women with diabetes are more likely to develop HF as their first CVD event, whereas individuals with diabetes from other race-sex groups are more likely to present first with ASCVD. These results can inform the tailoring of primary prevention therapies for either HF- or ASCVD-specific pathways based on individual-level risk.
患有前驱糖尿病和糖尿病的个体患动脉粥样硬化性心血管疾病（ASCVD）和心力衰竭（HF）的风险增加。在不同种族和性别的人群中，ASCVD 或 HF 哪个更有可能首先发生尚不清楚。
确定患有前驱糖尿病和糖尿病的黑人和白人男性和女性中，心血管事件亚组的首发竞争风险。
来自 6 个基于人群的队列的无 ASCVD 或 HF 的成年人的个体水平数据被汇总。我们根据种族和性别，在中年（40-59 岁）和老年（60-79 岁）成年人中，估计无 ASCVD、HF 和非心血管死亡的首发竞争累积发生率，其空腹血浆葡萄糖（FPG）正常（<100mg/dL）、前驱糖尿病（FPG 100-125mg/dL）和糖尿病（FPG≥126mg/dL 或使用抗高血糖药物）作为基线。在每个种族和性别组内，我们估计调整心血管风险因素后，前驱糖尿病和糖尿病患者相对于正常血糖患者的 ASCVD、HF 和非心血管死亡的风险调整后的危险比。
在 40117 名参与者中，随访了 638910 人年，发生了 5781 例 ASCVD 事件和 3179 例 HF 事件。在患有糖尿病的中年白人男性（35.4%比 11.6%）、黑人男性（31.6%比 15.1%）和白人女性（24.3%比 17.2%）中，ASCVD 作为首发事件的首发竞争累积发生率高于 HF，但在黑人女性中并非如此（26.4%比 28.4%）。在每个组内，糖尿病患者的 ASCVD 和 HF 的调整后的危险比明显高于正常 FPG 水平的成年人。在中年前驱糖尿病患者和老年前驱糖尿病或糖尿病患者中，发现结果基本相似。
患有糖尿病的黑人女性更有可能发生 HF 作为其首发 CVD 事件，而来自其他种族和性别的糖尿病患者更有可能首发 ASCVD。这些结果可以为基于个体风险的 HF 或 ASCVD 特定途径的主要预防治疗提供依据。
