Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, Hubei, China.
Front Endocrinol (Lausanne). 2023 Oct 24;14:1183075. doi: 10.3389/fendo.2023.1183075. eCollection 2023.
Heart failure with preserved ejection fraction (HFpEF), a major cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM), is frequently coexisted with obesity, poor glycemic, blood pressure (BP), and/or lipid control. We aimed to investigate the associations of nonalcoholic fatty liver disease (NAFLD) and its advanced fibrosis with HFpEF according to obesity, glycated hemoglobin A1c (HbA1c), BP, and low-density lipoprotein cholesterol (LDL-C) goal achievement status in T2DM patients.
A total of 2,418 T2DM patients who were hospitalized were cross-sectionally assessed. Liver fibrosis was evaluated by non-invasive biomarkers. Logistic regression analysis was used to evaluate the independent and combined associations of fibrosis status and diabetic care goal attainments with HFpEF risk.
Simple steatosis was not associated with HFpEF risk compared with patients without steatosis, while advanced liver fibrosis was found to have significantly higher odds for HFpEF risk (odds ratio,1.59; 95% confidence interval, 1.22-2.08). Advanced fibrosis in NAFLD was significantly associated with an increased risk of HFpEF, regardless of obesity status, HbA1c, BP, and LDL-C goal achievement status. P values for the interactions between fibrosis status and HbA1c control status, fibrosis status and BP control status, fibrosis status and LDL-C control status, and fibrosis status and body mass index (BMI) status on HFpEF risk were 0.021, 0.13, 0.001, and 0.23, respectively.
In patients with T2DM, advanced hepatic fibrosis was significantly associated with HFpEF risk, irrespective of obesity status, HbA1c, BP, and LDL-C goal attainment status. Further, HbA1c and LDL-C goal attainment status modified this association.
射血分数保留的心力衰竭（HFpEF）是 2 型糖尿病（T2DM）患者发病率和死亡率的主要原因，常伴有肥胖、血糖、血压（BP）和/或血脂控制不佳。我们旨在根据 T2DM 患者的非酒精性脂肪性肝病（NAFLD）及其肝纤维化的严重程度、肥胖、糖化血红蛋白 A1c（HbA1c）、BP 和低密度脂蛋白胆固醇（LDL-C）目标达标情况，探讨其与 HFpEF 的相关性。
共纳入 2418 例住院 T2DM 患者进行横断面评估。通过非侵入性生物标志物评估肝纤维化。采用 logistic 回归分析评估纤维化状态和糖尿病管理目标达标情况与 HFpEF 风险的独立和联合相关性。
单纯性脂肪变性与 HFpEF 风险无相关性，而进展性肝纤维化与 HFpEF 风险显著相关（比值比 1.59；95%置信区间 1.22-2.08）。无论肥胖、HbA1c、BP 和 LDL-C 目标达标状态如何，NAFLD 中的进展性纤维化与 HFpEF 风险的增加显著相关。纤维化状态与 HbA1c 控制状态、纤维化状态与 BP 控制状态、纤维化状态与 LDL-C 控制状态和纤维化状态与体重指数（BMI）状态之间对 HFpEF 风险的交互作用 P 值分别为 0.021、0.13、0.001 和 0.23。
在 T2DM 患者中，进展性肝纤维化与 HFpEF 风险显著相关，与肥胖、HbA1c、BP 和 LDL-C 目标达标状态无关。此外，HbA1c 和 LDL-C 目标达标状态改变了这种相关性。
