Discussion
obesity, HF, overweight, adiposity, Weight gain, weight loss, T2DM, diabetes
OBESITY, MINOR, RECRUITMENT, ADIPOSITY, ATHEROSCLEROSIS, DIABETES
This Patients with T2DM tend to be overweight and have a higher fat mass, WC, and HF risk than do those without diabetes (There are several potential biological mechanisms underlying the relationship between adiposity and the risk of HF. Weight gain increases the risk of atherosclerosis, which is the primary mechanism underlying the development of HF (Our study has several advantages. First, it is, to our knowledge, the first large-scale study with a long follow-up period focused on unintentional weight change and incident HF among patients with T2DM. The sample was sufficiently large to evaluate the association and conclusively examine sex and race interactions. We also used different indicators of obesity to verify the robustness of our findings. Second, in previous cohort studies, the dynamic features of body weight over time were overlooked, and weight was measured only twice per participant (Our results have several important clinical implications. In this observational study, unintentional increases in BMI and WC were positively associated with the incidence of HF among patients with T2DM. These observations underscore the need for this high-risk population to avoid excessive weight and WC fluctuations, particularly in cases of normal weight or overweight. Additional studies are needed to evaluate whether sustained weight loss and WC reduction are associated with the risk of HF.The present study had several limitations. First, our predefined outcomes did not distinguish between HF with a reduced ejection fraction (EF) and HF with a preserved EF. The effects of BMI and WC on HF may differ among HF subtypes. Second, it is difficult to establish causal relationships due to the nature of the study design. Third, the use of drugs that may be effective for HF, such as SGLT2 inhibitors and GLP-1 receptor agonists, was underrepresented because recruitment in the ACCORD study ceased in 2005. Therefore, adjustments for such factors were not made in the analysis. Fourth, all included patients were from the US and Canada, and these results may not apply to other populations (e.g., Asian populations) that exhibit different characteristics and lifestyles. Fifth, residual confounding cannot be averted in observational studies. However, we believe that residual confounding was a minor issue in the present study, as we adjusted for all known relevant confounders in HF incidence. Furthermore, the adjustments had little effect on the effect size.