Key result
Longer diabetes duration (≥10 years) and significant carotid artery stenosis additively increased the risk of MACE (HR 2.07) in patients with type 2 diabetes without prior cardiovascular disease.
Why the study?
Does a longer diabetes duration combined with significant carotid artery stenosis increase the risk of MACE in patients with type 2 diabetes without clinical cardiovascular disease?
Cohort (n=2,006)
No
Does a longer diabetes duration combined with significant carotid artery stenosis increase the risk of MACE in patients with type 2 diabetes without clinical cardiovascular disease?
Hazard Ratio: 2.07 (95% CI 1.17–3.66)
Absolute Event Rate: 20.2% vs 5.9%
p-value: p=0.012
In patients with type 2 diabetes without prior cardiovascular disease, the combination of a diabetes duration ≥10 years and significant carotid artery stenosis (50-69%) synergistically increases the risk of MACE and stroke.
Suggests combined duration and imaging markers may refine primary prevention risk stratification; leaves open.
BACKGROUND: We aimed to investigate the impact of diabetes duration and carotid artery stenosis (CAS) on the occurrence of major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM) without clinical cardiovascular disease. METHODS: A total of 2006 patients with T2DM, without clinical cardiovascular disease, aged >50 years, and who underwent baseline carotid Doppler ultrasound screening with regular follow-ups at the outpatient clinic of our diabetes center, were stratified into four subgroups according to diabetes duration and CAS degree. The primary outcomes included the occurrence of MACE, defined as fatal or nonfatal stroke and myocardial infarction, and all-cause mortality. RESULTS: The difference in the MACE incidence was significantly greater in patients with a longer diabetes duration (≥10 years) and significant CAS (50-69% luminal narrowing) (p < 0.001). Analysis of individual MACE components indicated a trend towards an increased incidence of stroke (p < 0.001), parallel to a longer diabetes duration and significant CAS. In contrast, the risk of myocardial infarction was significantly higher in patients with a diabetes duration <10 years and significant CAS (p = 0.039). Multivariate regression analysis showed that patients with both a longer diabetes duration and significant CAS demonstrated additive and very high risks of MACE (hazard ratio [HR], 2.07; 95% confidence interval [CI] 1.17-3.66; p = 0.012) and stroke (HR, 3.38; 95% CI 1.54-7.44; p = 0.002). CONCLUSIONS: The risk of MACE is significantly greater in patients with T2DM, without clinical cardiovascular disease, who have both a longer diabetes duration and significant CAS, compared with those who have a shorter duration and/or nonsignificant CAS.
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Noh et al. (2017) conducted a cohort in Type 2 diabetes mellitus without clinical cardiovascular disease (n=2,006). Longer diabetes duration (≥10 years) and significant carotid artery stenosis (50-69% narrowing) vs. Shorter diabetes duration (<10 years) and nonsignificant carotid artery stenosis was evaluated on Major adverse cardiovascular events (MACE), defined as fatal or nonfatal stroke and myocardial infarction, and all-cause mortality (HR 2.07, 95% CI 1.17-3.66, p=0.012). Longer diabetes duration (≥10 years) and significant carotid artery stenosis additively increased the risk of MACE (HR 2.07) in patients with type 2 diabetes without prior cardiovascular disease.