What is the clinical evidence from this study?

Study design: Cohort. Population: Type 2 diabetes (n=1870). Intervention: Severe arterial stiffness and poor glycemic control vs. Normal arterial stiffness and good glycemic control. Primary outcome: Macrovascular complications (coronary artery disease, cerebrovascular disease, and peripheral arterial disease) (HR 2.73, 95% CI 1.42-5.25, p=0.003).

November 28, 2022Open Access

Combined evaluation of arterial stiffness, glycemic control and hypertension for macrovascular complications in type 2 diabetes

Resultado clave

Severe arterial stiffness combined with poor glycemic control significantly increased the risk of macrovascular complications (HR 2.73) compared to normal arterial stiffness and good glycemic control in patients with type 2 diabetes.

Diseño del estudio

Tipo

Cohort (n=1,870)

Multicéntrico

PICO estructurado

Does a combined evaluation of arterial stiffness, glycemic control, and hypertension predict the risk of macrovascular complications in patients with type 2 diabetes?

Población

1,870 patients with type 2 diabetes from the Beijing Health Management Cohort, mean age 59.90 years.

Intervención

Presence of severe arterial stiffness combined with poor glycemic control and/or hypertension (evaluated via a composite risk score of 0-4).

Comparador

Normal arterial stiffness combined with good glycemic control and/or absence of hypertension.

Resultado

Onset of diabetic macrovascular complications at median 4.0 years follow-up.composite

A combined evaluation of arterial stiffness, glycemic control, and hypertension status effectively stratifies the risk of macrovascular complications in patients with type 2 diabetes.

Resultado numérico

Estimación del efecto: HR 2.73 (95% CI 1.42-5.25)

Tasa de eventos absoluta: 29.1% vs 8.2%

valor p: p=0.003

Limitaciones

Fasting blood glucose was used as a measure of glycemic control because only 56% of the population had HbA1c measurements
Brachial-ankle pulse wave velocity (baPWV) was used instead of carotid-femoral pulse wave velocity (cfPWV)
Arterial stiffness, glycemic control, and blood pressure were determined only at baseline without tracking dynamic changes
Self-reported history of cardiovascular diseases could cause recall bias
Observational study design leaves potential for unmeasured confounding factors

Resumen

BACKGROUND: Arterial stiffness, glycemic control and blood pressure are risk factors of macrovascular complications in type 2 diabetes. This study aimed to investigate the combined association of arterial stiffness, glycemic control and hypertension status with the occurrence of diabetic macrovascular complication. METHODS: A total of 1870 patients of diabetes were enrolled from Beijing Health Management Cohort between 2008 and 2018 as baseline, and then followed for macrovascular complication onset. We proposed a composite risk score (0-4) by arterial stiffness severity, pool glycemic control and hypertension status. Cox model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI). RESULTS: The mean age (SD) of this population was 59.90 (12.29) years. During a median follow-up of 4.0 years, 359 (19.2%) patients developed macrovascular complication. Compared to the normal arterial stiffness and good glycemic control group, patients with severe arterial stiffness and pool glycemic control had the highest risk of macrovascular complications (HR: 2.73; 95% CI: 1.42-5.25). Similarly, those of severe arterial stiffness and hypertension had the highest risk (HR: 2.69; 95% CI: 1.61-4.50). Patients of the composite score > 2 had a significantly increased risk of macrovascular complication. CONCLUSION: This study suggested the clinical importance of combined evaluation of arterial stiffness, glycemic control and hypertension status for the risk stratification and management of macrovascular complication of type 2 diabetes.

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