Kaze Arnaud D, Bertoni Alain G, Fox Ervin R, Hall Michael E, Mentz Robert J, Berry Jarett D, Echouffo-Tcheugui Justin B
Division of Cardiology, Banner-University Medical Center Phoenix, The University of Arizona College of Medicine, Phoenix, AZ.
Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC.
Diabetes Care. 2025 Mar 1;48(3):464-472. doi: 10.2337/dc24-0654.
To assess the extent to which the concomitant presence of subclinical myocardial injury or stress and diabetes affects the risk of heart failure (HF) subtypes.
The Jackson Heart Study included Black adults, categorized based on diabetes status, high-sensitivity cardiac troponin I (hs-cTnI), and brain natriuretic peptide (BNP) levels. Subclinical myocardial injury was defined as hs-cTnI ≥4 ng/L in women and ≥6 ng/L in men, and subclinical myocardial stress as BNP ≥35 pg/mL. The study outcomes included incident HF, HF with preserved ejection fraction (HFpEF), and HF with reduced ejection fraction (HFrEF).
Among 3,484 participants (mean age 54.6 years, 63.2% women, 22.3% with diabetes, 26.4% with subclinical myocardial injury, 9.4% with subclinical myocardial stress), 306 developed HF (151 HFpEF and 139 HFrEF) over 12 years. Compared with individuals with no diabetes and no subclinical myocardial injury at recruitment, participants with diabetes and subclinical myocardial injury had a higher HF risk (hazard ratio [HR] 3.84, 95% CI 2.60-5.66), HFpEF (HR 3.68, 95% CI 2.13-6.36), and HFrEF (HR 4.26, 95% CI 2.40-7.53). The HRs associated with the presence of diabetes and subclinical myocardial stress versus their joint absence were 4.03 (95% CI 2.50-6.51), 5.71 (95% CI 3.11-10.47), and 2.13 (95% CI 0.88-5.17) for HF, HFpEF, and HFrEF, respectively. There was no significant diabetes status and cardiac biomarkers interaction.
Both diabetes and subclinical myocardial damage significantly increase the risk of all HF types among Black individuals.
评估亚临床心肌损伤或应激与糖尿病同时存在对心力衰竭（HF）亚型风险的影响程度。
杰克逊心脏研究纳入了成年黑人，根据糖尿病状态、高敏心肌肌钙蛋白I（hs-cTnI）和脑钠肽（BNP）水平进行分类。亚临床心肌损伤定义为女性hs-cTnI≥4 ng/L，男性≥6 ng/L，亚临床心肌应激定义为BNP≥35 pg/mL。研究结局包括新发HF、射血分数保留的HF（HFpEF）和射血分数降低的HF（HFrEF）。
在3484名参与者中（平均年龄54.6岁，女性占63.2%，糖尿病患者占22.3%，亚临床心肌损伤患者占26.4%，亚临床心肌应激患者占9.4%），12年间有306人发生HF（151例HFpEF和139例HFrEF）。与招募时无糖尿病且无亚临床心肌损伤的个体相比，患有糖尿病和亚临床心肌损伤的参与者发生HF的风险更高（风险比[HR] 3.84，95%可信区间[CI] 2.60 - 5.66），HFpEF（HR 3.68，95% CI 2.13 - 6.36），以及HFrEF（HR 4.26，95% CI 2.40 - 7.5）。糖尿病和亚临床心肌应激存在与两者均不存在相比，HF、HFpEF和HFrEF的HR分别为4.03（95% CI 2.50 - 6.51）、5.71（95% CI 3.11 - 10.47）和2.13（95% CI）。糖尿病状态与心脏生物标志物之间无显著相互作用。
糖尿病和亚临床心肌损伤均显著增加黑人个体患所有类型HF的风险。
