心力衰竭患者中的糖尿病与短期死亡率风险因素的效应修饰：来自哥伦比亚心力衰竭登记处（RECOLFACA）的观察性研究。
Diabetes mellitus in patients with heart failure and effect modification of risk factors for short-term mortality: An observational study from the Registro Colombiano de Falla Cardíaca (RECOLFACA).
机构信息
Departamento de Cardiología, Fundación Cardiovascular de Colombia, Bucaramanga, Colombia.
Departamento de Cardiología, Clínica Cardio VID, Medellín, Colombia.
出版信息
Biomedica. 2024 May 31;44(Sp. 1):182-197. doi: 10.7705/biomedica.6951.
INTRODUCTION
Heart failure and type 2 diabetes mellitus are critical public health issues.
OBJECTIVE
To characterize the risk factors for mortality in patients with heart failure and type 2 diabetes mellitus from a large registry in Colombia and to evaluate the potential effect modifications by type 2 diabetes mellitus over other risk factors.
MATERIALS AND METHODS
Heart failure patients with and without type 2 diabetes mellitus enrolled in the Registro Colombiano de Falla Cardíaca (RECOLFACA) were included. RECOLFACA enrolled adult patients with heart failure diagnosis from 60 medical centers in Colombia during 2017-2019. The primary outcome was all-cause mortality. Survival analysis was performed using adjusted Cox proportional hazard models.
RESULTS
A total of 2514 patients were included, and the prevalence of type 2 diabetes mellitus was 24.7% (n = 620). We found seven independent predictors of short-term mortality for the general cohort, chronic obstructive pulmonary disease, sinus rhythm, triple therapy, nitrates use, statins use, anemia, and hyperkalemia. In the type 2 diabetes mellitus group, only the left ventricle diastolic diameter was an independent mortality predictor (HR = 0.96; 95% CI: 0.93-0.98). There was no evidence of effect modification by type 2 diabetes mellitus on the relationship between any independent predictors and all-cause mortality. However, a significant effect modification by type 2 diabetes mellitus between smoking and mortality was observed.
CONCLUSIONS
Patients with type 2 diabetes mellitus had higher mortality risk. Our results also suggest that type 2 diabetes mellitus diagnosis does not modify the effect of the independent risk factors for mortality in heart failure evaluated. However, type 2 diabetes mellitus significantly modify the risk relation between mortality and smoking in patients with heart failure.
简介
心力衰竭和 2 型糖尿病是严重的公共卫生问题。
目的
从哥伦比亚的一个大型登记处描述心力衰竭和 2 型糖尿病患者死亡的危险因素，并评估 2 型糖尿病对其他危险因素的潜在效应修饰作用。
材料和方法
纳入了患有和不患有 2 型糖尿病的心力衰竭患者，这些患者均来自于哥伦比亚的 60 个医疗中心的 Registro Colombiano de Falla Cardíaca（RECOLFACA）。RECOLFACA 在 2017-2019 年期间招募了患有心力衰竭诊断的成年患者。主要结局是全因死亡率。使用调整后的 Cox 比例风险模型进行生存分析。
结果
共纳入 2514 例患者，2 型糖尿病的患病率为 24.7%（n=620）。我们发现一般队列中有 7 个独立的短期死亡率预测因素，分别为慢性阻塞性肺疾病、窦性节律、三联疗法、硝酸盐使用、他汀类药物使用、贫血和高钾血症。在 2 型糖尿病组中，只有左心室舒张直径是独立的死亡率预测因素（HR=0.96；95%CI：0.93-0.98）。没有证据表明 2 型糖尿病对任何独立预测因素与全因死亡率之间的关系有修饰作用。然而，在吸烟与死亡率之间观察到 2 型糖尿病的显著效应修饰作用。
结论
患有 2 型糖尿病的患者有更高的死亡风险。我们的结果还表明，2 型糖尿病的诊断并不能改变心力衰竭评估中死亡率的独立危险因素的作用。然而，2 型糖尿病显著改变了心力衰竭患者死亡率与吸烟之间的风险关系。
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