Key result
Increasing aortic stiffness is linked to ~3.4-fold higher mortality risk versus stable stiffness in T2D.
Why the study?
The prognostic importance of changes in aortic stiffness for adverse cardiovascular outcomes and mortality had never been investigated in patients with type 2 diabetes.
Do changes in aortic stiffness predict adverse cardiovascular outcomes and mortality in individuals with type 2 diabetes?
Cohort (n=417)
No
Do changes in aortic stiffness predict adverse cardiovascular outcomes and mortality in individuals with type 2 diabetes?
Effect estimate: HR 3.39 (95% CI 1.81-6.35)
p-value: p=<0.001
Changes in aortic stiffness, including both increases and extreme reductions, are significant predictors of adverse cardiovascular outcomes and mortality in patients with type 2 diabetes.
Serial aortic stiffness monitoring may stratify mortality risk in type 2 diabetes; leaves open whether modifying stiffness improves outcomes.
BACKGROUND: The prognostic importance of changes in aortic stiffness for the occurrence of adverse cardiovascular outcomes and mortality has never been investigated in patients with type 2 diabetes. We aimed to evaluate it in a cohort of 417 patients. METHODS: Changes in aortic stiffness were assessed by 2 carotid-femoral pulse wave velocity (CF-PWV) measurements performed over a 4-year period. Multivariable Cox analysis examined the associations between changes in CF-PWV, evaluated as a continuous variable with splines and as categorical ones (quartiles and stable/reduction/increase subgroups), and the occurrence of total cardiovascular events (CVEs), major adverse CVEs (MACEs), and all-cause and cardiovascular mortality. RESULTS: Over a median follow-up of 8.2 years after the 2nd CF-PWV measurement, there were 101 total CVEs (85 MACEs) and 135 all-cause deaths (64 cardiovascular). As a continuous variable, the lowest risk nadir was at -2.5%/year of CF-PWV change, with significantly higher risks of mortality associated with CF-PWV increases, but no excess risks at extremes of CF-PWV reduction. Otherwise, in categorical analyses, patients in the 1st quartile (greatest CF-PWV reductions) had excess risks of all-cause and cardiovascular mortality (hazard ratios [HRs]: 2.0-2.7), whereas patients in 3rd quartile had higher risks of all outcomes (HRs: 2.0-3.2), in relation to the lowest risk 2nd quartile subgroup. Patients in the 4th quartile had higher risks of all-cause mortality. Categorization as stable/reduction/increase subgroups was confirmatory, with higher risks at greater reductions (HRs: 1.7-3.3) and at greater increases in CF-PWV (HRs: 1.9-3.4), in relation to those with stable CF-PWV. CONCLUSIONS: Changes in aortic stiffness, mainly increases and possibly also extreme reductions, are predictors of adverse cardiovascular outcomes and mortality in individuals with type 2 diabetes.
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Cardoso et al. (2022) conducted a cohort in Type 2 diabetes (n=417). Increased aortic stiffness (CF-PWV > +1%/year) vs. Stable aortic stiffness (CF-PWV -1% to +1%/year) was evaluated on All-cause mortality (HR 3.39, 95% CI 1.81-6.35, p=<0.001). Increases in aortic stiffness over a 4-year period were associated with a 3.39-fold higher risk of all-cause mortality compared to stable aortic stiffness in patients with type 2 diabetes.
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