Objective

There is a paucity of information regarding how cardiovascular risk factors (RF) modulate the impact of diabetes mellitus (DM) on the heart failure hospitalization (HFH) risk following an acute myocardial infarction (AMI).

Methods

Adult survivors of an AMI were retrospectively identified from the 2014 US Nationwide Readmissions Database. The impact of DM on the risk for a 6-month HFH was studied in subgroups of RFs using multivariable logistic regression to adjust for baseline risk differences. Individual interactions of DM with RFs were tested.

Results

Of 237,549 AMI survivors, 37.2% patients had DM. Primary outcome occurred in 12,934 patients (5.4%), at a 106% higher rate in DM patients (7.9% vs 4.0%, p < 0.001), which was attenuated to a 45% higher adjusted risk. Higher HFH risk in DM patients was consistent across subgroups and significant interactions were present between DM and other RFs. The increased HFH risk with DM was more pronounced in patients without certain HF RFs compared with those with these RFs [age < 65: OR for DM 1.84 (1.58–2.13) vs age ≥ 65: OR 1.34 (1.24–1.45); HF absent during index AMI: OR for DM 1.87 (1.66–2.10) vs HF present: OR 1.24 (1.14–1.34); atrial fibrillation absent: OR for DM 1.57 (1.46–1.68) vs present: OR 1.19 (1.06–1.33); P_interaction < 0.001 for all]. Similar results were noted for hypertension and chronic kidney disease.

Conclusions

AMI survivors with DM had a higher risk of 6-month HFHs. The impact of DM on the increased HFH risk was more pronounced in patients without certain RFs suggesting that more aggressive preventive strategies related to DM and HF are needed in these subgroups to prevent or delay the onset of HFHs.

中文翻译：

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糖尿病与心血管危险因素的相互作用对心肌梗死后心力衰竭住院的影响

客观的

关于心血管危险因素 (RF) 如何调节糖尿病 (DM) 对急性心肌梗死 (AMI) 后心力衰竭住院 (HFH) 风险的影响的信息很少。

方法

从 2014 年美国全国再入院数据库中回顾性地确定了 AMI 的成年幸存者。在 RF 亚组中研究了 DM 对 6 个月 HFH 风险的影响，使用多变量逻辑回归调整基线风险差异。测试了 DM 与 RF 的个体相互作用。

结果

在 237,549 名 AMI 幸存者中，37.2% 的患者患有 DM。主要结果发生在 12,934 名患者 (5.4%) 中，在 DM 患者中发生率高出 106%（7.9% 对 4.0%，p  < 0.001），调整后风险降低至高出 45%。DM 患者较高的 HFH 风险在各亚组中是一致的，并且 DM 和其他 RF 之间存在显着的相互作用。与有这些 RF 的患者相比，没有某些 HF RF 的患者增加 DM 的 HFH 风险更为明显[年龄 < 65：DM 的 OR 1.84 (1.58-2.13) vs 年龄 ≥ 65：OR 1.34 (1.24-1.45)；指数 AMI 期间没有 HF：DM 1.87 (1.66–2.10) 与 HF 存在：OR 1.24 (1.14–1.34)；无心房颤动：或 DM 1.57 (1.46–1.68) 与存在：OR 1.19 (1.06–1.33)；P_交互 < 0.001 全部]。高血压和慢性肾病也有类似的结果。

结论

患有 DM 的 AMI 幸存者发生 6 个月 HFH 的风险更高。DM 对 HFH 风险增加的影响在没有特定 RF 的患者中更为明显，这表明在这些亚组中需要更积极的与 DM 和 HF 相关的预防策略来预防或延缓 HFH 的发作。