Background Diabetes exerts adverse effects on the heart, and a longer diabetes duration is associated with greater heart failure risk. We studied diabetes duration and subclinical myocardial injury, as reflected by high-sensitivity cardiac troponin (hs-cTnT). Methods We analyzed 9052 participants without heart failure or coronary heart disease (mean age 63 years, 58% female, 21% Black, 15% with diabetes) at The Atherosclerosis Risk in Communities Study (ARIC) Visit 4 (1996 to 1998). Diabetes duration was calculated based on diabetes status at Visits 1 (1987 to 1989) through 4, or using self-reported age of diabetes diagnosis prior to Visit 1. We used multinomial logistic regression to determine the association of diabetes duration with increased (≥14 ng/L) or detectable (≥6 ng/L) Visit 4 hs-cTnT, relative to undetectable hs-cTnT, adjusted for demographics and cardiovascular risk factors. Results The prevalence of increased Visit 4 hs-cTnT was higher in persons with longer diabetes duration, from 12% for those with diabetes 0 to <5 years up to 31% among those with diabetes for ≥15 years (P for trend <0.0001). New onset diabetes at Visit 4 was associated with 1.92× higher relative risk (95% CI, 1.27–2.91) of increased hs-cTnT than no diabetes. Longer diabetes duration was associated with greater myocardial injury, with duration ≥15 years associated with 9.29× higher risk (95% CI, 5.65–15.29) for increased hs-cTnT and 2.07× (95% CI, 1.24–3.16) for detectable hs-cTnT, compared to no diabetes. Conclusions Longer diabetes duration is strongly associated with subclinical myocardial injury. Interventional studies are needed to assess whether the prevention and delay of diabetes onset can mitigate early myocardial damage.

中文翻译：

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糖尿病持续时间和亚临床心肌损伤：社区动脉粥样硬化风险研究 (ARIC)

背景 糖尿病对心脏有不利影响，糖尿病持续时间越长，心力衰竭风险越高。我们研究了糖尿病持续时间和亚临床心肌损伤，如高敏心肌肌钙蛋白 (hs-cTnT) 所反映的那样。方法 我们分析了社区动脉粥样硬化风险研究 (ARIC) 第 4 次访问（1996 年至 1998 年）中的 9052 名没有心力衰竭或冠心病的参与者（平均年龄 63 岁，58% 为女性，21% 为黑人，15% 患有糖尿病）。糖尿病持续时间是根据第 1 次（1987 年至 1989 年）至第 4 次就诊时的糖尿病状态或使用第 1 次就诊前自我报告的糖尿病诊断年龄计算的。我们使用多项逻辑回归来确定糖尿病病程与增加（≥14 ng/L) 或可检测 (≥6 ng/L) 访问 4 hs-cTnT，相对于不可检测的 hs-cTnT，针对人口统计学和心血管危险因素进行了调整。结果 在糖尿病病程较长的人群中，第 4 次就诊 hs-cTnT 升高的患病率较高，从 0 至 <5 年糖尿病患者的 12% 到 ≥15 年糖尿病患者的 31%（P 趋势 < 0.0001）。第 4 次就诊时新发糖尿病与 hs-cTnT 增加的相对风险比无糖尿病高 1.92 倍（95% CI，1.27–2.91）相关。糖尿病持续时间越长与心肌损伤越严重相关，持续时间≥15 年与 hs-cTnT 升高的风险增加 9.29 倍（95% CI，5.65-15.29）和可检测到的 hs 的风险增加 2.07 倍（95% CI，1.24-3.16）相关-cTnT，与无糖尿病相比。结论 较长的糖尿病病程与亚临床心肌损伤密切相关。