Finerenone对心力衰竭患者胰岛素抵抗的影响：FINEARTS-HF试验的启示

IF 10.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

European Journal of Heart Failure Pub Date : 2025-09-08 DOI:10.1002/ejhf.70034

John W Ostrominski,Brian L Claggett,Akshay S Desai,Pardeep S Jhund,Carolyn S P Lam,Michele Senni,Sanjiv J Shah,Adriaan A Voors,Faiez Zannad,Bertram Pitt,Katja Rohwedder,Meike Brinker,Patrick Schloemer,John J V McMurray,Scott D Solomon,Muthiah Vaduganathan

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Among 5851 (98%) participants with a calculable eGDR (median [interquartile range] 5.1 [3.9-6.3] mg/kg/min), lower eGDR was associated with greater albuminuria and worse HF-related health status at baseline. Compared with participants with eGDR ≥5.1 mg/kg/min, those with eGDR <5.1 mg/kg/min experienced a 63% higher rate of cardiovascular death and total HF events (adjusted rate ratio [aRR] 1.63; 95% confidence interval [CI] 1.41-1.87; p < 0.001). Similar findings were observed in participants with diabetes (aRR 1.72; 95% CI 1.40-2.12) and without diabetes (aRR 1.34; 95% CI 1.07-1.68; pinteraction = 0.06). Lower baseline eGDR was additionally associated with a higher rate of vascular events, kidney outcomes, new-onset diabetes, and all-cause death. Treatment benefits of finerenone on cardiovascular death and total HF events (pinteraction = 0.64) and new-onset diabetes (pinteraction = 0.36) appeared consistent irrespective of baseline eGDR category. 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引用次数: 0

摘要

目的：估计葡萄糖处置率（eGDR）是一种简单、无创的胰岛素抵抗测量方法。在FINEARTS-HF的探索性分析中，我们评估了较低的eGDR（反映更大的胰岛素抵抗）是否与心力衰竭（HF）的不良结局相关。方法和结果eGDR在基线时使用腰围、糖化血红蛋白和高血压状态计算。根据基线eGDR（<中位数或≥中位数）评价芬尼酮的临床结局和治疗效果。在5851名（98%）具有可计算的eGDR（中位数[四分位数间距]5.1 [3.9-6.3]mg/kg/min）的参与者中，较低的eGDR与较高的蛋白尿和较差的基线hf相关健康状况相关。与eGDR≥5.1 mg/kg/min的受试者相比，eGDR <5.1 mg/kg/min的受试者心血管死亡和总心衰事件发生率高63%（校正率比[aRR] 1.63； 95%可信区间[CI] 1.41-1.87; p < 0.001）。在糖尿病患者（aRR 1.72; 95% CI 1.40-2.12）和非糖尿病患者（aRR 1.34; 95% CI 1.07-1.68； p相互作用= 0.06）中也观察到类似的结果。较低的基线eGDR还与较高的血管事件、肾脏结局、新发糖尿病和全因死亡发生率相关。芬尼酮对心血管死亡和总心衰事件（p相互作用= 0.64）以及新发糖尿病（p相互作用= 0.36）的治疗益处与基线eGDR类别无关。基线eGDR分类没有改变芬烯酮的安全性。结论：eGDR是一种有效的胰岛素抵抗指标，与心衰患者（包括非糖尿病患者）的心血管、肾脏和代谢结局广泛相关。芬尼酮降低了心血管结局和新发糖尿病的风险，与基线胰岛素抵抗无关。临床试验注册：clinicaltrials .gov NCT04435626。

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Finerenone according to insulin resistance in heart failure: Insights from the FINEARTS-HF trial.

AIMS The estimated glucose disposal rate (eGDR) is a simple, non-invasive measure of insulin resistance. In this exploratory analysis of FINEARTS-HF, we evaluated whether lower eGDR, reflecting greater insulin resistance, is associated with adverse outcomes in heart failure (HF). METHODS AND RESULTS The eGDR was calculated at baseline using waist circumference, glycated haemoglobin, and hypertension status. Clinical outcomes and treatment effects of finerenone according to baseline eGDR (

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来源期刊

European Journal of Heart Failure 医学-心血管系统

CiteScore

27.30

自引率

11.50%

发文量

365

审稿时长

1 months

期刊介绍： European Journal of Heart Failure is an international journal dedicated to advancing knowledge in the field of heart failure management. The journal publishes reviews and editorials aimed at improving understanding, prevention, investigation, and treatment of heart failure. It covers various disciplines such as molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, clinical sciences, social sciences, and population sciences. The journal welcomes submissions of manuscripts on basic, clinical, and population sciences, as well as original contributions on nursing, care of the elderly, primary care, health economics, and other related specialist fields. It is published monthly and has a readership that includes cardiologists, emergency room physicians, intensivists, internists, general physicians, cardiac nurses, diabetologists, epidemiologists, basic scientists focusing on cardiovascular research, and those working in rehabilitation. The journal is abstracted and indexed in various databases such as Academic Search, Embase, MEDLINE/PubMed, and Science Citation Index.

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