A Propensity-Matched Study of the Association of Diabetes Mellitus With Incident Heart Failure and Mortality Among Community-Dwelling Older Adults

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• 作者：Brita  ; Roy MD ; MPH ; MS^a ; Pushkar P.  ; Pawar MBBS ; MPH^a ; Ravi V.  ; Desai MD^b ; Gregg C.  ; Fonarow MD^c ; Marjan  ; Mujib MBBS ; MPH^a ; Yan  ; Zhang MS ; MPH^a ; Margaret A.  ; Feller MPH^a ; Fernando  ; Ovalle MD^a ; Inmaculada B.  ; Aban PhD^a ; Thomas E.  ; Love PhD^d ; Ami E.  ; Iskandrian MD^a ; Prakash  ; Deedwania MD^e ; Ali  ; Ahmed MD ; MPH^a ;   ; ^f ;   ; ^{aahmed@uab.edu}
• 刊名：The American Journal of Cardiology
• 出版年：2011
• 出版时间：15 December 2011
• 年：2011
• 卷：108
• 期：12
• 页码：1747-1753
• 全文大小：1249 K

文摘

Diabetes mellitus (DM) is a risk factor for incident heart failure (HF) in older adults. However, the extent to which this association is independent of other risk factors remains unclear. Of 5,464 community-dwelling adults ?5 years old in the Cardiovascular Health Study without baseline HF, 862 had DM (fasting plasma glucose levels ?26 mg/dl or treatment with insulin or oral hypoglycemic agents). Propensity scores for DM were estimated for each of the 5,464 participants and were used to assemble a cohort of 717 pairs of participants with and without DM who were balanced in 65 baseline characteristics. Incident HF occurred in 31 % and 26 % of matched participants with and without DM, respectively, during >13 years of follow-up (hazard ratio 1.45 for DM vs no DM, 95 % confidence interval [CI] 1.14 to 1.86, p = 0.003). Of the 5,464 participants before matching unadjusted and multivariable-adjusted hazard ratios for incident HF associated with DM were 2.22 (95 % CI 1.94 to 2.55, p <0.001) and 1.52 (95 % CI 1.30 to 1.78, p <0.001), respectively. All-cause mortality occurred in 57 % and 47 % of matched participants with and without DM, respectively (hazard ratio 1.35, 95 % CI 1.13 to 1.61, p = 0.001). Of matched participants DM-associated hazard ratios for incident peripheral arterial disease, incident acute myocardial infarction, and incident stroke were 2.50 (95 % CI 1.45 to 4.32, p = 0.001), 1.37 (95 % CI 0.97 to 1.93, p = 0.072), and 1.11 (95 % CI 0.81 to 1.51, p = 0.527), respectively. In conclusion, the association of DM with incident HF and all-cause mortality in community-dwelling older adults without HF is independent of major baseline cardiovascular risk factors.