JACC:成年人糖尿病合并心肌病的流行率和预后影响因素

2021-10-19 MedSci原创 MedSci原创

2型糖尿病(T2D)越来越多

在美国,2型糖尿病(T2D)影响了超过3400万的成年人,而且预计患病率还会增加。在糖尿病患者中,血管疾病(CVD)是导致死亡的主要原因。心力衰竭(HF)在糖尿病患者最初出现的心血管疾病中占了很大比例。

糖尿病患者从高危阶段(A期HF)过渡到过度/C期HF不是一个一步到位的过程,而是通过发展中间阶段(B期HF)发生的,其特点是心脏结构和/或功能异常--糖尿病心肌病(DbCM)的亚临床状态,在已发表的数据中也被称为糖尿病心肌病。

糖尿病与心脏重塑的异常和HF的高风险有关。为了评估社区居民中糖尿病合并心肌病(DbCM)的发病率和预后影响,来自美国德克萨斯大学的心血管病专家开展了相关研究,结果发表在JACC杂志上。

研究人员从3个队列研究(ARIC[社区动脉硬化风险]、CHS[心血管健康研究]、CRIC[慢性肾功能不全队列])中汇集了没有流行性心血管疾病或HF的成年人。在患有糖尿病的参与者中,使用不同的定义来定义DbCM。1)最小限制性:≥1个超声心动图异常(左心房扩大、左心室肥厚、舒张功能障碍);2)中间限制性:≥2个超声心动图异常;3)最大限制性:N端前BNP水平升高(正常/超重者>125或肥胖者>100 pg/ml)加上≥2个超声心动图异常。调整后的Fine-Gray模型被用来评估HF的风险。

结果显示,在糖尿病患者中(10208人中的2900人),DbCM的患病率在最低和最严格的标准中分别为67.0%至11.7%。较高的空腹血糖、身体质量指数和年龄以及较差的肾功能与较高的DbCM风险有关。患有DbCM的参与者中,HF的5年发病率在最低和最严格的定义中分别为8.4%-12.8%。

糖尿病合并心肌病的患病率结果

与优生优育相比,DbCM与发生HF的高风险明显相关,最严格的DbCM定义的风险最高(HR=2.55[95%CI:1.69-3.86];最不严格的标准HR=1.99[95%CI:1.50-2.65])。在不同的队列研究、不同的性别和种族亚组以及没有高血压或肥胖症的参与者中观察到类似的结果模式。

综上,无论用什么标准来定义心肌病,DbCM都能确定一个发展为HF的高风险亚组。

 

参考文献:

Prevalence and Prognostic Implications of Diabetes With Cardiomyopathy in Community-Dwelling Adults. J Am Coll Cardiol. 2021 Oct, 78 (16) 1587–1598

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    2022-06-18 lixiaol
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    2022-04-05 hbwxf
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低GI膳食与更低的2型糖尿病、心血管疾病、糖尿病相关癌症和全因死亡风险有关,且低GI膳食的临床获益与增加纤维和全谷物摄入量的益处相当。这些发现支持将GI作为碳水质量的指标,纳入到成人的饮食推荐中。