Heart Failure Epidemiology in Patients With Diabetes Mellitus Without Coronary Heart Disease

Background

Epidemiology of patients with comorbid heart failure (HF) and diabetes mellitus (DM) without coronary heart disease (CHD) is not well described.

射血分数保留性心力衰竭合并糖尿病的研究进展

心力衰竭是一种心脏结构或功能异常所致的临床综合征,据推测目前中国心血管病患者人数为2.9亿,其中心力衰竭占据450万。依据左心室射血分数,心力衰竭又分为射血分数降低性心力衰竭(HFrEF)和射血分数保留性心力衰竭(HFpEF)。近年来,HFpEF的发病率明显较HFrEF增加且已成为研究的热点。高血压、糖尿病和冠心病是常见能导致心力衰竭的基础疾病,其中糖尿病是最常见合并症之一。在美国,糖尿病在HFpEF中的患病率约为45%,但人们对这一人群的特征和结果了解甚少,在中国更是这样。现总结几项HFpEF治疗临床试验的数据,这些数据都表明糖尿病与HFpEF的发病率和长期死亡率增加有关,并讨论了HFpEF和糖尿病中的几种常见病理机制,包括钠潴留、代谢紊乱、骨骼肌功能受损和潜在的治疗靶点。随着对合并HFpEF和糖尿病的理解的增加,希望能为临床医生更好地提供有效的治疗方法。     

Type 2 Diabetes Mellitus and Heart Failure,A Scientific Statement From the American Heart Association and Heart Failure Society of America

Type 2 diabetes mellitus is a risk factor for incident heart failure and increases the risk of morbidity and mortality in patients with established disease. Secular trends in the prevalence of diabetes mellitus and heart failure forecast a growing burden of disease and underscore the need for effective therapeutic strategies. Recent clinical trials have demonstrated the shared pathophysiology between diabetes mellitus and heart failure, the synergistic effect of managing both conditions, and the potential for diabetes mellitus therapies to modulate the risk of heart failure outcomes. This scientific statement on diabetes mellitus and heart failure summarizes the epidemiology, pathophysiology, and impact of diabetes mellitus and its control on outcomes in heart failure; reviews the approach to pharmacological therapy and lifestyle modification in patients with diabetes mellitus and heart failure; highlights the value of multidisciplinary interventions to improve clinical outcomes in this population; and outlines priorities for future research.     

Admission Plasma Glucose and Diabetes Mellitus in Elderly Admissions to Hospital

Over 6 months, all admissions to three geriatric wards were studied to define an admission plasma glucose level (APG) that identified previously undiagnosed diabetes mellitus. Subjects with APG≥7.0 mmol l⁻¹ had a modified oral glucose tolerance test (OGTT) when well before discharge if their dose of steroid and/or thiazide was constant, and they were neither terminally ill nor dead; excluded were 1 subject on reducing steroid doses, and 9 moribund admissions without APG. If the first 2 h OGTT result was ≥11.1 mmol l⁻¹, a second OGTT was performed 6 weeks later to fulfil 1985 WHO criteria. Subjects with APG<7.0 mmol l⁻¹ did not have OGTT. Seventy had a previous diagnosis of diabetes; scrutiny of records and OGTT refuted the diagnosis in 5, who were excluded from further analysis. Diabetes was only commonly found among those with APG≥8.0 mmol l⁻¹, and the proportion was small until APG≥13 mmol l⁻¹, although even then only 47 % (95 % CI 21–73 %) had diabetes. Fourteen of 28 subjects with initial OGTT results suggesting diabetes were not diabetic on retesting. Inpatient mortality was higher if APG≥7.0 (Odds ratio 2.82; CI 1.63–4.89) or the subject had known diabetes (Odds ratio 2.43; CI 1.15–4.97) compared to APG<7; there was no age or sex difference between these three groups. We conclude that, unless overtly diabetic, diagnosis of diabetes in elderly medical admissions needs later confirmation. © 1997 by John Wiley & Sons, Ltd.     

Epidemiology of Diabetes Mellitus in the Elderly in Northern Greece: a Population Study

This population based study was undertaken to ascertain the overall prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in the elderly using the WHO criteria. The role of obesity in the development of DM or IGT has been investigated for both sexes per decade of age. Furthermore the potential for DM to increase with age, as has been suggested before, has been evaluated using the IGT as a proportion of total glucose intolerance (IGT/TGI) for the same parts of the tested sample. From the 647 persons registered as elderly people in a small town in northern Greece (total population 5875 people), 66 persons did not participate in this survey. Fifty-six subjects (9.7%) had previously diagnosed DM. The remainder were tested using fasting blood glucose measurements or an oral glucose tolerance test (OGTT). The prevalence of previously undiagnosed DM according to fasting blood glucose values or after 2 h of 75 g load values was 10.1% and 9.3%, respectively. Thus the overall prevalence of DM was 29.1% and of IGT was 15.1%. These data support an increased frequency of DM (65% previously undiagnosed) and IGT in the elderly, whereas this population's susceptibility seems to decline in the older groups for both sexes. Obesity remains a risk factor for DM and IGT particularly among the younger groups although its role has been found to decline with age.     

Clinical Features, Treatment Practices, and Hospital and Long-Term Outcomes of Older Patients Hospitalized with Decompensated Heart Failure: The Worcester Heart Failure Study

OBJECTIVES: To examine age-specific differences in clinical presentation, receipt of therapeutic practices and lifestyle recommendations, and hospital and long-term survival in patients hospitalized for acute heart failure HF.
DESIGN: Population-based study.
SETTING: The Worcester Heart Failure Study, a population-based study of residents of the a large Central New England metropolitan area hospitalized for decompensated HF at 11 greater-Worcester medical centers.
PARTICIPANTS: Four thousand five hundred thirty-four patients hospitalized for decompensated HF during 1995 and 2000.
MEASUREMENTS: Medical records were reviewed for demographic, clinical, and treatment characteristics and hospital survival status. Long-term follow-up of discharged hospital patients was conducted through 2005. Patients were compared according to four age groups (<65, 65–74, 75–84, and ≥85).
RESULTS: Mean age was 76; 24.0% were aged 85 and older. Patients aged 75 and older were more likely to be female and to have multiple comorbidities, a lower body mass index at the time of hospitalization, and higher ejection fraction findings. Older patients were significantly more likely to receive symptom-modifying medications and less likely to receive disease-modifying medications than younger patients. Older age was directly associated with higher in-hospital, 30-day, and 1-year death rates in crude and multivariable-adjusted analyses.
CONCLUSION: The results of this community-wide study suggest that clinical, treatment, and prognostic factors differ according to age in patients hospitalized for decompensated HF. These high-risk patients warrant special attention in future studies to improve their management and long-term survival.     

老年慢性心力衰竭患者临床特点

【】: 目的 分析老年慢性心力衰竭患者的临床特征。方法 选择2010年7月至2014年12月确诊的老年慢性心衰住院患者78例,根据年龄分为普通老年组和高龄老年组,收集患者一般资料、入院后检查结果及药物治疗情况,包括：年龄、有无心衰相关性疾病(高血压、糖尿病、冠心病、肾功能不全),入院时心率、血压,入院后血肌酐、电解质、胸片有无肺淤血、超声心动图指标)、住院期间血浆BNP(Brain Natriuretic Peptide)水平变化以及药物治疗情况(主要指β- 受体阻滞剂,ACEI 或者ARB,强心剂、利尿剂等)。住院期间给予标准化抗心衰治疗并在出院前评估心功能,检测血浆BNP水平。结果 普通老年患者抗心衰治疗后心功能分级心功能Ⅰ Ⅱ级为26 %,心功能Ⅲ级为63%,心功能Ⅳ级为11%,而高龄老年患者 则分别为21%、60%和19%;出院时BNP水平分别为267.7±106.2(pg/mL)和401.5±98.9(pg/mL) 结论 高龄老年患者抗心衰治疗后心功能分级及BNP水平高于普通老年患者。     

铁代谢与心力衰竭关系的研究进展

心力衰竭(心衰)是由各种原因导致的心脏疾病的终末阶段,为当今社会常见的严重疾病,具有发病率高和死亡率高的特点.铁是人体必须的微量元素之一,以离子形式存在于肝、脾、肾、心、骨骼肌和脑等组织中,广泛参与人体的多种生理活动,而铁的代谢平衡是维持人体生命活动的重要部分.多项研究发现铁的代谢与心衰存在一定关系,影响心衰患者的疾病...     

糖尿病对急性ST段抬高型心肌梗死后心力衰竭的影响

目的:观察糖尿病患者急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)后心力衰竭(心衰)的特点,及其与非糖尿病患者的异同。方法:以STEMI后发生心衰的患者为研究对象,选取2001-01-01至2005-12-01入住我院的此类患者1036例,搜集其临床资料、住院期间治疗和转归情况,依据是否患有糖尿病,将所有研究对象分别纳入糖尿病组(n=320)和非糖尿病组(n=716)。统计两组患者的超声心动图特点,比较两组急性期心衰的特点、治疗及转归,以logistic回归模型分析糖尿病对STEMI后急性期心源性死亡的影响。结果:糖尿病组存在多种危险因素,其多支血管病变发生率显著高于非糖尿病组(P<0.001)。超声心动图结果显示两组患者左心室射血分数、左心房以及左心室舒张末的内径、左心室收缩和舒张末容积的差异两组间无统计学意义;但两组患者二尖瓣舒张早期峰速度(E)与二尖瓣舒张晚期峰速度(A)比值<1、1～2、≥2时差异有统计学意义。Logistic回归模型调整前后,糖尿病对住院期间心源性死亡的终点风险(HR)分别为2.4(95CI1.9～3.0,...     

Is a fall just a fall: correlates of falling in healthy older persons. The Health,Aging and Body Composition Study

OBJECTIVES: To identify factors associated with falling in well-functioning older people. DESIGN: Cross-sectional analyses of report of falls over the past 12 months using baseline data from the Health, Aging and Body Composition Study. SETTING: Clinic examinations in Pittsburgh, Pennsylvania, or Memphis, Tennessee. PARTICIPANTS: Three thousand seventy-five high-functioning black and white elderly aged 70 to 79 living in the community. MEASUREMENTS: Physical function assessed using self-report and performance measures. Health status indicators included diseases, medication use, and body composition measures. RESULTS: Almost one-quarter (24.1%) of women and 18.3% of men reported at least one fall within the year before the baseline examination. Fallers were more likely to be female; white; report more chronic diseases and medications; and have lower leg strength, poorer balance, slower 400-meter walk time, and lower muscle mass. In men, multivariate logistic regression models showed white race (adjusted odds ratio (OR) = 1.4, 95% confidence interval (CI) = 1.2-1.6), slower 6-meter walk speed (OR = 1.1, 95% CI = 1.0-1.3), poor standing balance (OR = 1.2, 95% CI = 1.0-1.4), inability to do 5 chair stands (OR = 1.7, 95% CI = 1.3-1.9), report of urinary incontinence (UI) (OR = 1.5, 95% CI = 1.1-2.0), and mid-quintile of leg muscle strength (OR = 0.6, 95% CI = 0.4-0.9) to be independently associated with report of falling. In women, benzodiazepine use (OR = 1.6, 95% CI = 1.0-2.6), UI (OR = 1.5, 95% CI = 1.2-1.9), and reported difficulty in rising from a chair (OR = 1.4, 95% CI = 1.2-1.6) were associated with past falls. CONCLUSION: Falls history needs to be screened in healthier older adults. Even for well-functioning older persons, specific correlates of falling can be identified to define those at risk.