China: Study on Macrovascular Complications in Type 2 Diabetes

A recent study published in Cardiovascular Diabetology has indicated the clinical importance of the combined evaluation of glycemic and hypertension control and arterial stiffness to improve the risk of macrovascular complications among patients with type 2 diabetes.

In type 2 diabetes patients, blood pressure, glycemic control, and arterial stiffness are reported to be risk factors for macrovascular complications. Adverse macrovascular events include cerebrovascular disease, coronary heart disease, and peripheral artery disease. They have become the primary cause of impaired life quality and mortality in diabetes, resulting in severe health and economic burden.

Against the above background, Zhiyuan Wu, Capital Medical University, Youanmen Street, Beijing, China, and their colleague, therefore, aimed to examine the combined association of glycemic control, arterial stiffness, and hypertension status with diabetic macrovascular complications.

For this purpose, the researchers enrolled 1870 diabetes patients from the Beijing Health Management Cohort. They were then followed for the onset of macrovascular complications. They proposed a composite risk score (0–4) by the severity of arterial stiffness, hypertension status, and poor glycemic control. The hazard ratio (HR) was estimated using the hazard ratio (HR).

Findings

• The mean age of this population was 59.90 years. During a median follow-up of 4.0 years, 19.2% of patients developed macrovascular complications.
• Patients with severe arterial stiffness and poor glycemic control, compared to the standard arterial stiffness and good glycemic control group had the greatest risk of macrovascular complications (HR: 2.73).
• Patients with hypertension and severe arterial stiffness had the highest risk (HR: 2.69).
• Patients with a composite score > 2 had a significantly increased risk of macrovascular complications.

"Findings from longitudinal cohort study suggested that the combined evaluation of glycemic control, arterial stiffness, and hypertension status could improve the risk stratification of macrovascular complications in diabetes patients," the researchers wrote in their study. Among patients with poor glycemic control or hypertension, the effect becomes notable from the moderate arterial stiffness.

"This provided novel insights into the preventive strategies against macrovascular complications from the perspective of combined intervention of glucose metabolism and arterial function."

In addition, the authors also established a cumulative and weighted risk score by arterial stiffness, hypertension status, and glycemic control for the risk stratification of diabetic macrovascular complications.

Reference

Wu, Z., Yu, S., Zhang, H. et al. Combined evaluation of arterial stiffness, glycemic control and hypertension for macrovascular complications in type 2 diabetes. Cardiovasc Diabetol 21, 262 (2022). https://doi.org/10.1186/s12933-022-01696-1