Association between cardiometabolic risk factors cluster and all‐cause mortality in type 2 diabetes

OBJECTIVE: To investigate the association between the cardiometabolic risk factors cluster (CRFC) and all-cause mortality in type 2 diabetes (T2D). METHODS: Data from the Zhejiang Rural T2D Cohort (2016-2024) included 10,310 participants. Four cardiometabolic risk factors (CRFs) were evaluated: central obesity, elevated blood pressure, high triglycerides (TG), and low high-density lipoprotein cholesterol (HDL-C). After adjusting for confounders, multivariate Cox regression models were constructed to estimate hazard ratios (HRs). A Total CRFs Score (TCRFS), weighted by regression coefficients of individual CRFs, was stratified into four groups based on quartiles (<P25, P25-P50, P50-P75, and ≥P75). The TCRFS and TCRFS-based groupings were analyzed for associations with all-cause mortality, including age- and sex-stratified analyses. RESULTS: Participants had a mean age of 63.54 ± 9.77 years, with the most prevalent CRFs being elevated blood pressure (86.97%), followed by elevated TG (41.21%), low HDL-C (38.71%), and central obesity (32.96%). Over a mean 8.12 ± 1.71 years of follow-up, 1,770 deaths occurred (death density: 211.21/10,000 person-years). No single CRF, except for TG, showed a significant association with all-cause mortality, whereas the TCRFS was a significant predictor (HR = 2.719, 95%CI (1.360, 5.437), p = 0.005). Furthermore, participants in the highest TCRFS quartile (≥P75) had a significantly higher mortality risk compared to those in the lowest quartile (<P25) (HR = 1.155, 95% CI: 1.030-1.294, P = 0.013). CONCLUSION: CRFC is significantly associated with increased all-cause mortality risk in T2D patients. Early comprehensive assessment and intervention for cardiometabolic risk factors may reduce mortality in this population.