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Prognostic Impact of Aortic Stiffness in High-Risk Type 2 Diabetic Patients The Rio de Janeiro Type 2 Diabetes Cohort Study
被引:94
作者:
Cardoso, Claudia R. L.
[1
]
Ferreira, Marcel T.
[1
]
Leite, Nathalie C.
[1
]
Salles, Gil F.
[1
]
机构:
[1] Univ Fed Rio de Janeiro, Dept Internal Med, Univ Hosp Clementino Fraga Filho, Sch Med, Rio De Janeiro, Brazil
关键词:
PULSE-WAVE VELOCITY;
AMBULATORY BLOOD-PRESSURE;
EXPERT CONSENSUS DOCUMENT;
STAGE RENAL-DISEASE;
ARTERIAL STIFFNESS;
CARDIOVASCULAR-DISEASE;
INDEPENDENT PREDICTOR;
HYPERTENSIVE PATIENTS;
OLDER-ADULTS;
ALL-CAUSE;
D O I:
10.2337/dc13-0506
中图分类号:
R5 [内科学];
学科分类号:
1002 ;
100201 ;
摘要:
OBJECTIVEThe prognostic importance of carotid-femoral pulse wave velocity (PWV), the gold standard measure of aortic stiffness, has been scarcely investigated in type 2 diabetes and never after full adjustment for potential confounders. The aim was to evaluate the prognostic impact of carotid-femoral PWV for cardiovascular morbidity and all-cause mortality in a cohort of 565 high-risk type 2 diabetic patients.RESEARCH DESIGN AND METHODSClinical, laboratory, ambulatory blood pressure (BP) monitoring, and carotid-femoral PWV data were obtained at baseline. The primary end points were a composite of fatal and nonfatal cardiovascular events and all-cause mortality. Multiple Cox survival analysis was used to assess the associations between carotid-femoral PWV, as a continuous variable and categorized at 10 m/s, and the end points.RESULTSAfter a median follow-up of 5.75 years, 88 total cardiovascular events and 72 all-cause deaths occurred. After adjustments for potential cardiovascular risk factors, including micro- and macrovascular complications, ambulatory BP, and metabolic control, carotid-femoral PWV was predictive of the composite end point but not of all-cause mortality both as a continuous variable (hazard ratio 1.13 [95% CI 1.03-1.23], P = 0.009 for increments of 1 m/s) and as categorized at 10 m/s (1.92 [1.16-3.18], P = 0.012). On sensitivity analysis, carotid-femoral PWV was a better predictor of cardiovascular events in younger patients (<65 years), in those with microvascular complications, and in those with poorer glycemic control (HbA(1c) 7.5% [58.5 mmol/mol]).CONCLUSIONSCarotid-femoral PWV provides cardiovascular risk prediction independent of standard risk factors, glycemic control, and ambulatory BPs and improves cardiovascular risk stratification in high-risk type 2 diabetes.
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页码:3772 / 3778
页数:7
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