Correlation Analysis Of New-onset Fasting Blood Glucose Levels In Patients With Chronic Heart Failure And Their Therapeutic Drugs

Purpose: During the management of patients with chronic heart failure(CHF),we found that the fasting blood-glucose(FBG)level of some patients with no abnormal glucose metabolism will increase,and even progress to diabetes.There are few studies on the influencing factors of newly-onset FBG increase in CHF patients,especially in the treatment of heart failure(HF).Therefore,this study intends to retrospectively explore the relationship between HF treatment drugs and newly-onset FBG increase in CHF patients.Methods: This study collected patients hospitalized from May 1,2017 to May 1,2019 were found from the medical record database of the electronic medical record HIS system of the Subei People’s hospital,and select patients with newly diagnosed CHF without abnormal glucose metabolism.Enrolled patients have to be satisfied,the FBG of the patient before enrollment is less than 6.1mmol/L,the main treatment plan for heart failure was stable,and there are follow-up data that can be traced back within 18 months.According to the occurrence of FBG≥ 6.1mmol/L or not during the follow-up,the patients were divided into: elevated group and normal group.Baseline data analysis was performed by SPSS software,gender、age、body mass index(BMI)、previous history、N-terminal-forebrain natriuretic peptide(NT-proBNP)、biochemical 、blood lipids、various indicators in echocardiography,and therapeutic drugs were compared between the two groups.Analyze these indicators by single-factor and multi-factor Logistic regression,and screen out the statistically significant indicators.Finally,a line chart and cumulative incidence curve were drawn to further analyze related drugs.Result:1.Include informationA total of 231 patients were enrolled in this study,Among them,62 patients(26.8%)in the elevated group,their baseline FBG level was 5.14±0.08 mmol/L.After 18 months of observation,the average FBG of the patients was 6.93±0.10 mmol/L.The average time for the new-onset FBG level to rise was 12.8±0.6 months,and the average age was 73.1±1.5 years old;169 patients(73.2%)in the normal group,they had a baseline FBG level of 5.02±0.04mmol/L.After 18 months of observation,The mean value of FBG was 5.03±0.04 mmol/L,and the mean age was 69.0±0.9 years old.Patients were taken drugs:The percentage of patients who used loop-diuretic(Loop-DIUT)was accounted for 83.5%;the percentage of spironolactone was 89.2%;the percentage of angiotensin-converting enzyme inhibitors(ACEI)was accounted for33.3%,angiotensin II receptor blockers(ARB)accounted for 33.8%,angiotensin receptor enkephalin inhibitor(ARNI)accounted for 21.2%,beta blockers(BB)accounted for 53.7%,dihydropyridine calcium channel blocker(DHP CCB)accounted for 10.0%,digoxin(DIG)accounted for 31.2%;Trimetazidine(TMZ)accounted for22.9%.2.Single factor analysis Discover the patient’s BMI,age,systolic pressure(SBP),heart rate(HR),smoking history,hypertension(HBP)history,coronary heart disease(CHD)history,abnormal renal function History,NT-proBNP,Creatinine(CRE),Urea(UREA),Uric Acid(UA),Total Cholesterol(CHO),New York Heart Association(NYHA)Class III and the use of Furosemide,Torasemide,ACEI,ARB,BB,DHP CCB,DIG,combined use of three diuretics and other factors have statistically significant effects on the newly increase of the FBG levels(P<0.05).3.Multi-factor correction analysis Through multivariate analysis,it was found that: BMI(OR=1.421,95%CI:1.199-1.683),smoking(OR=4.036,95%CI: 1.288-12.646),NT-proBNP(OR=1.000,95%CI: 1.000-1.000),CHO(OR=2.186,95%CI: 1.098-4.356)and the use of ACEI drugs(OR=0.126,95%CI: 0.028-0.562),ARB drugs(OR=0.041,95%CI: 0.08-0.200),DHP CCB drugs(OR=31.015,95%CI: 4.775-201.451),etc.They were independent influencing factors of newly-onset elevated FBG levels in CHF patients(P<0.05).Among them,DHP CCB drugs,BMI,smoking,NT-proBNP,CHO will increase the risk of new FBG elevation,while,the use of ACEI and ARB drugs will reduce the risk of patients with elevated FBG levels.4.Line chart and cumulative incidence curve Seen from the line chart,it can be found that the treatment plan that does not contain renin-angiotensin system inhibitor(RASI)drugs have a higher risk of increased FBG levels than the treatment plan that contains RASI drugs.The cumulative incidence curve suggests that the use of RASI can reduce the incidence of increased FBG levels in patients with heart failure,and the difference is statistically significant(P=0.031 after correction).Conclusion:1.Age,BMI,SBP,HR,history of smoking,history of HBP,history of CHD,history of abnormal renal function,NYHA level III,and elevated levels of NT-proBNP,CRE,UREA,UA,and CHO are risk factors for new elevated FBG levels in CHF patients.2.The use of Furosemide,Torsemide,DHP CCB,BB,ACEI,ARB,and the combined application of 3 diuretics at the same time are statistically significant factors influencing the increase of FBG levels in CHF patients.3.The use of DHP CCB,ACEI,ARB etc,as well as the patient’s BMI indicators,smoking history,NT-proBNP,CHO,all are the independent influencing factors for the increase of new FBG levels in CHF patients.Among them,BMI,smoking,NT-proBNP,DHP CCB drugs,and CHO are the risk factors for newly-onset elevated FBG in CHF patients,and the use of ACEI and ARB drugs are protective factors for their newly-onset elevated FBG.4.In most combinations which has the RASI drugs,the probability of a patient’s newly-onset elevated FBG level is low.The cumulative incidence curve suggests that the use of RASI can reduce the incidence of increased FBG levels.