OBJECTIVE The impact of comprehensive risk factor control on heart failure (HF) risk and HF-free survival time in individuals with type 2 diabetes (T2D) was evaluated in this study. RESEARCH DESIGN AND METHODS This prospective study included 11,949 individuals diagnosed with T2D, matched with 47,796 non-T2D control study participants from the UK Biobank cohort. The degree of comprehensive risk factor control was assessed on the basis of the major cardiovascular risk factors, including blood pressure, BMI, LDL cholesterol, hemoglobin A1c, renal function, smoking, diet, and physical activity. Cox proportional hazards models were used to measure the associations between the degree of risk factor control and HF risk. Irwin’s restricted mean was used to evaluate HF-free survival time. RESULTS During a median follow-up of 12.3 years, 702 individuals (5.87%) with T2D and 1,402 matched control participants (2.93%) developed HF. Each additional risk factor controlled was associated with an average 19% lower risk of HF. Optimal control of at least six risk factors was associated with a 67% lower HF risk (hazard ratio [HR] 0.33; 95% CI 0.20, 0.54). BMI was the primary attributable risk factor for HF. Notably, the excess risk of HF associated with T2D could be attenuated to levels comparable to those of non-T2D control participants when individuals had a high degree of risk factor control (HR 0.66; 95% CI 0.40, 1.07), and they exhibited a longer HF-free survival time. CONCLUSIONS Comprehensive management of risk factors is inversely associated with HF risk, and optimal risk factor control may prolong HF-free survival time among individuals with T2D.

中文翻译：

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全面控制 2 型糖尿病的多重风险因素以降低心力衰竭风险：前瞻性队列研究的见解


目的 本研究评估了综合危险因素控制对 2 型糖尿病 (T2D) 患者心力衰竭 (HF) 风险和无 HF 生存时间的影响。研究设计和方法 这项前瞻性研究包括 11,949 名被诊断患有 T2D 的个体，与来自英国生物银行队列的 47,796 名非 T2D 对照研究参与者进行匹配。根据主要心血管危险因素，包括血压、BMI、LDL胆固醇、糖化血红蛋白、肾功能、吸烟、饮食和体力活动等，评估综合危险因素控制程度。 Cox比例风险模型用于衡量危险因素控制程度与心力衰竭风险之间的关联。欧文限制均值用于评估无心衰生存时间。结果 在中位随访 12.3 年期间，702 名 T2D 患者（5.87%）和 1,402 名匹配的对照参与者（2.93%）出现心力衰竭。每控制一个额外的风险因素，心衰风险平均降低 19%。至少六个风险因素的最佳控制与心衰风险降低 67% 相关（风险比 [HR] 0.33；95% CI 0.20，0.54）。 BMI 是心力衰竭的主要危险因素。值得注意的是，当个体风险因素控制程度较高时（HR 0.66；95% CI 0.40，1.07），与非 T2D 对照参与者相比，与 T2D 相关的 HF 过度风险可能会降低至相当的水平，并且他们表现出更长的无 HF 生存时间。结论 风险因素的综合管理与心力衰竭风险呈负相关，最佳的风险因素控制可以延长 T2D 患者的无心力衰竭生存时间。