Panchal Kajal, Lawson Claire, Shabnam Sharmin, Khunti Kamlesh, Zaccardi Francesco
Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, UK.
Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
Diabetes Metab Res Rev. 2025 Sep;41(6):e70072. doi: 10.1002/dmrr.70072.
AIMS/HYPOTHESIS: Recent evidence shows decreasing trends for ischaemic heart disease over time in the general population as well as in those with type 2 diabetes. As type 2 diabetes has been associated with an increased risk of both ischaemic and non-ischaemic heart failure, a greater proportion of people with type 2 diabetes could now be presenting with non-ischaemic heart failure phenotypes. We aimed to investigate the risk of incident ischaemic and non-ischaemic heart failure in people with type 2 diabetes.
We used the Clinical Practice Research Datalink primary care data, linked to hospital and mortality records, to identify newly diagnosed adults with type 2 diabetes between 2000 and 2021, who were matched to up to four people without diabetes by sex, year of birth, and general practice. Ischaemic heart failure was defined as incident heart failure at or following an ischaemic heart disease event; non-ischaemic HF was defined as incident heart failure in the absence of prevalent ischaemic heart disease. We used Poisson and Royston-Parmar models to estimate, respectively, the incidence rates and the hazard ratios (adjusted for sociodemographic and clinical confounders) for ischaemic and non-ischaemic heart failure, comparing people with type 2 diabetes to those without diabetes.
In a cohort of 1,621,090 people (mean age, 60.1 years; 52.8% women; 532,185 with type 2 diabetes), during a median follow-up of 5.8 (interquartile range: 2.6-10.3) years, a heart failure event occurred in 20,016 (3.8%) people with type 2 diabetes (ischaemic: 5046; non-ischaemic: 14,970) and in 29,835 (2.7%) without diabetes (7001 and 22,834, respectively). Age-standardised rates were higher for non-ischaemic (3.18 [95% CI: 3.09-3.27] vs. 2.08 [2.03-2.12] per 1000 person-years in men with type 2 diabetes vs. without diabetes; and 2.47 [2.39-2.54] vs. 1.57 [1.53-1.61], respectively, in women) than ischaemic (corresponding estimates: 1.57 [1.51-1.63] vs. 0.95 [0.92-0.98] and 0.80 [0.76-0.84] vs. 0.46 [0.44-0.48]) heart failure. Comparing people with type 2 diabetes versus those without diabetes, the hazard ratios were larger for ischaemic (adjusted hazard ratio: 1.36 [1.28-1.45] and 1.30 [1.20-1.42] in men and women, respectively) than non-ischaemic (1.12 [1.07-1.16] and 1.10 [1.06-1.14], respectively) heart failure.
CONCLUSIONS/INTERPRETATIONS: The higher rates of non-ischaemic heart failure highlight the need for early prevention before ischaemic heart disease develops, regardless of type 2 diabetes. Meanwhile, the greater excess risk of ischaemic heart failure in those with type 2 diabetes suggests suboptimal post-ischaemic prevention in this group.
目的/假设：最近的证据表明，一般人群以及2型糖尿病患者中，缺血性心脏病的发病率呈下降趋势。由于2型糖尿病与缺血性和非缺血性心力衰竭的风险增加有关，现在可能有更大比例的2型糖尿病患者表现为非缺血性心力衰竭表型。我们旨在调查2型糖尿病患者发生缺血性和非缺血性心力衰竭的风险。
我们使用临床实践研究数据链的初级保健数据，并与医院和死亡率记录相链接，以识别2000年至2021年间新诊断的2型糖尿病成年人，这些患者按性别、出生年份和全科医疗与多达四名非糖尿病患者进行匹配。缺血性心力衰竭定义为在缺血性心脏病事件发生时或之后发生的心力衰竭；非缺血性心力衰竭定义为在无缺血性心脏病的情况下发生的心力衰竭。我们分别使用泊松模型和罗伊斯顿-帕尔马模型来估计缺血性和非缺血性心力衰竭的发病率和风险比（针对社会人口统计学和临床混杂因素进行调整），并将2型糖尿病患者与非糖尿病患者进行比较。
在一个包含1,621,090人的队列中（平均年龄60.1岁；52.8%为女性；532,185人患有2型糖尿病），在中位随访5.8年（四分位间距：2.6 - 10.3年）期间，20,016名（3.8%）2型糖尿病患者发生心力衰竭事件（缺血性：5046例；非缺血性：14,970例），29,835名（2.7%）非糖尿病患者发生心力衰竭事件（分别为7001例和22,834例）。非缺血性心力衰竭的年龄标准化发病率更高（2型糖尿病男性每1000人年为3.18 [95%置信区间：3.09 - 3.27]，非糖尿病男性为2.08 [2.03 - 2.12]；2型糖尿病女性每1000人年为2.47 [2.39 - 2.54]，非糖尿病女性为1.57 [1.53 - 1.61]），高于缺血性心力衰竭（相应估计值：1.57 [1.51 - 1.63]对0.95 [0.92 - 0.98]，0.80 [0.76 - 0.84]对0.46 [0.44 - 0.48]）。将2型糖尿病患者与非糖尿病患者进行比较，缺血性心力衰竭的风险比更大（男性调整后风险比：1.36 [1.28 - 1.45]，女性为1.30 [1.20 - 1.42]），高于非缺血性心力衰竭（分别为1.12 [1.07 - 1.16]和1.10 [1.06 - 1.14]）。
结论/解读：非缺血性心力衰竭的较高发病率凸显了在缺血性心脏病发生之前进行早期预防的必要性，无论是否患有2型糖尿病。同时，2型糖尿病患者缺血性心力衰竭的额外风险更高，表明该组患者缺血后预防措施欠佳。
