What is the clinical evidence from this study?

Study design: Cohort. Population: Type 2 diabetes mellitus (n=2714). Intervention: Higher brachial-ankle pulse wave velocity (baPWV ≥1672 cm/s) vs. Lower baPWV (<1672 cm/s). Primary outcome: Composite cardiovascular events (cardiac death, non-fatal myocardial infarction, coronary revascularization, and stroke) (HR 2.00, 95% CI 1.31-3.07, p=0.001).

What question did this study set out to answer?

To investigate whether arterial stiffness measured by brachial-ankle pulse wave velocity predicts long-term cardiovascular events in individuals with type 2 diabetes mellitus.

November 11, 2022MedicineOpen Access

Brachial-ankle pulse wave velocity as a predictor of long-term cardiovascular events in 2174 subjects with type 2 diabetes mellitus: A retrospective cohort study

Q: What are the key findings of this study?

Higher brachial-ankle pulse wave velocity (≥1672 cm/s) was associated with a significantly increased risk of composite cardiovascular events (HR 2.00) in patients with type 2 diabetes mellitus.

Q: What question did this study set out to answer?

To investigate whether arterial stiffness measured by brachial-ankle pulse wave velocity predicts long-term cardiovascular events in individuals with type 2 diabetes mellitus.

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Key result

Higher brachial-ankle pulse wave velocity (≥1672 cm/s) was associated with a significantly increased risk of composite cardiovascular events (HR 2.00) in patients with type 2 diabetes mellitus.

Why the study?

The prognostic value of arterial stiffness in patients with diabetes mellitus remains unclear.

Key Points

To investigate whether arterial stiffness measured by brachial-ankle pulse wave velocity predicts long-term cardiovascular events in individuals with type 2 diabetes mellitus.
Retrospective cohort study of 2,714 patients with type 2 diabetes mellitus (mean age 63.6 years; 59.3% male) without baseline cardiovascular disease or stroke.
Followed participants over a median of 3.84 years (interquartile range, 1.60–5.52 years) to assess a composite endpoint of cardiac death, non-fatal myocardial infarction, coronary revascularization, and stroke using multivariable Cox proportional hazards regression.
A total of 118 composite cardiovascular events (4.3%) occurred during the follow-up period.
Elevated brachial-ankle pulse wave velocity (≥1672 cm/s) independently predicted composite cardiovascular events after multivariable adjustment (HR, 2.00; 95% CI, 1.31–3.07; P = .001).
Compared with the lowest tertile, risk increased progressively in the middle tertile (HR, 1.84; 95% CI, 1.03–3.27; P = .037) and highest tertile (HR, 2.97; 95% CI, 1.69–5.22; P < .001).

Study Design

Type

Cohort (n=2,714)

Multicenter

Structured PICO

Population

2,714 adults aged 19-90 with type 2 diabetes mellitus and no prior cardiovascular disease, followed for a median of 3.84 years.

Exposure

Higher brachial-ankle pulse wave velocity (baPWV ≥1672 cm/s or higher tertiles)

Comparator

Lower brachial-ankle pulse wave velocity (baPWV <1672 cm/s or lowest tertile)

Outcome

Composite cardiovascular events of cardiac death, non-fatal myocardial infarction, coronary revascularization and stroke at median 3.84 years follow-upcomposite

Main Result

Hazard Ratio: 2 (95% CI 1.31–3.07)

p-value: p=0.001

Higher brachial-ankle pulse wave velocity (≥1672 cm/s) is an independent predictor of long-term cardiovascular events in patients with type 2 diabetes mellitus without prior cardiovascular disease.

Limitations

Retrospective study design and single-center enrollment limit generalizability.
Only Korean people were enrolled, so the cutoff value or results may differ in other races.
Detailed information about DM severity and complications was not collected.
Patients with low ABI (<0.9) were excluded, which may have affected the lack of association between ABI and outcomes.
No data on how changes in baPWV over time affect prognosis.
The area under the curve for the baPWV cutoff value was not high, indicating suboptimal sensitivity and specificity.
Retrospective study design and single center enrollment
Only Korean people enrolled, limiting generalizability to other races
Detailed information about DM and its complications (duration, insulin use, microvascular complications) was not collected
ABI was not associated with clinical outcomes, possibly due to excluding patients with ABI <0.9
Lack of data on how changes in baPWV affect prognosis
Area under the curve was not high enough to make a definitive decision for a cutoff value

Implication

May refine CV risk assessment in DM; leaves open incremental value over standard predictors in prospective studies.

Abstract

The prognostic value of arterial stiffness in patients with diabetes mellitus (DM) remains unclear. The aim of this study was to investigate the association between brachial-ankle pulse wave velocity (baPWV) and the occurrence of cardiovascular events in people with DM. A total of 2714 subjects (mean age, 63.6 years; males, 59.3%) with type 2 DM and without documented cardiovascular disease and stroke were analyzed. The primary end-point of this study was composite cardiovascular events of cardiac death, non-fatal myocardial infarction, coronary revascularization and stroke. There were 118 composite events (4.3%) during a median follow-up period of 3.84 years (interquartile range, 1.60-5.52 years). In multivariable Cox regression analysis, higher baPWV (≥1672 cm/s) was associated with composite events even after controlling for potential confounders (hazard ratio [HR], 2.00; 95% confidence interval [CI], 1.31-3.07; P = .001). Compared to the lowest baPWV tertile, both middle (HR, 1.84; 95% CI, 1.03-3.27; P = .037) and the highest (HR, 2.97; 95% CI, 1.69-5.22; P < .001) tertile of baPWV were associated with increased risk of cardiovascular events in the same multivariable model. In conclusion, the baPWV was associated with cardiovascular events in people with type 2 DM. Considering the simplicity and convenience of baPWV measurement, baPWV may be useful for risk stratification of people with type 2 DM.

Discussion

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Published by Medicine · CC BY-NC

Cite This Study

Kim et al. (2022) conducted a cohort in Type 2 diabetes mellitus (n=2,714). Higher brachial-ankle pulse wave velocity (baPWV ≥1672 cm/s) vs. Lower baPWV (<1672 cm/s) was evaluated on Composite cardiovascular events (cardiac death, non-fatal myocardial infarction, coronary revascularization, and stroke) (HR 2.00, 95% CI 1.31-3.07, p=0.001). Higher brachial-ankle pulse wave velocity (≥1672 cm/s) was associated with a significantly increased risk of composite cardiovascular events (HR 2.00) in patients with type 2 diabetes mellitus.

synapsesocial.com/papers/6a9aab5b4555fef441868c5d https://doi.org/10.1097/md.0000000000031758

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Implication

May refine CV risk assessment in DM; leaves open incremental value over standard predictors in prospective studies.

Brachial-ankle pulse wave velocity as a predictor of long-term cardiovascular events in 2174 subjects with type 2 diabetes mellitus: A retrospective cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Brachial-ankle pulse wave velocity as a predictor of long-term cardiovascular events in 2174 subjects with type 2 diabetes mellitus: A retrospective cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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