Key result
Severe peripheral neuropathy and severe diastolic impairment were associated with increased risk of CV events and all-cause death (HR 2.23, 95% CI 1.06-4.68 and HR 2.27, 95% CI 1.16-4.44).
Why the study?
To investigate the association between peripheral neuropathy, impaired left ventricular diastolic function, and prognosis in patients with T1DM without known CVD, and to test their incremental prognostic value beyond the Steno T1 Risk Engine.
Are peripheral neuropathy and impaired diastolic function associated with an increased risk of cardiovascular events and all-cause death in patients with type 1 diabetes without known cardiovascular disease?
Cohort (n=946)
Are peripheral neuropathy and impaired diastolic function associated with an increased risk of cardiovascular events and all-cause death in patients with type 1 diabetes without known cardiovascular disease?
In patients with type 1 diabetes without known cardiovascular disease, peripheral neuropathy and impaired diastolic function are independent predictors of cardiovascular events and all-cause death, and measures of diastolic function improve risk prediction beyond established models.
May refine risk stratification in T1D without known CVD; leaves open need for prospective validation before practice change.
AIMS: To investigate the association between measures of peripheral neuropathy (PN) and impaired left ventricular diastolic function, and the prognosis in patients with type 1 diabetes (T1DM) and no known cardiovascular disease (CVD), and to test the incremental prognostic value of including measures of PN and diastolic function to the established Steno T1 Risk Engine. METHODS: Echocardiography and quantitative biothesiometry was performed to evaluate diastolic function and PN. The participants were categorized according to severity of diastolic function and PN. The study endpoint was combined cardiovascular (CV) events and all-cause death. Associations were analysed using multivariable regression models. The prognostic capability was assessed with Harrell's C-statistics and tested against the Steno T1 Risk Engine. RESULTS: A total of 946 individuals (51.5% men) were included. The mean (SD) follow-up was 6 (1.3) years. The total number of CV events and all-cause death were 100. In the multi-adjusted analysis, both PN and impaired diastolic function were associated with increased risk of CV events and all-cause death: severe PN versus no PN: hazard ratio (HR) 2.23 (95% confidence interval [CI] 1.06-4.68; P = 0.035); severe diastolic impairment versus normal function: HR 2.27 (95% CI 1.16-4.44; P = 0.016). Measures of diastolic function improved prognostic capability when added to the Steno T1 Risk Engine: C-statistic 0.797 (95% CI 0.793-0.817) versus 0.785 (95% CI 0.744-0.825; P = 0.006). CONCLUSION: Peripheral neuropathy and impaired diastolic function are associated with an increased risk of CV events and all-cause death in patients with T1DM. Measures of diastolic function improved prediction of prognosis by the Steno T1 Risk Engine.
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Hansen et al. (2020) conducted a cohort in Type 1 diabetes mellitus without known cardiovascular disease (n=946). Severe peripheral neuropathy vs. No peripheral neuropathy was evaluated on Combined cardiovascular (CV) events and all-cause death (HR 2.23, 95% CI 1.06-4.68, p=0.035). Severe peripheral neuropathy and severe diastolic impairment were associated with increased risk of CV events and all-cause death (HR 2.23, 95% CI 1.06-4.68 and HR 2.27, 95% CI 1.16-4.44).
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