Effects of metabolic parameters’ variability on cardiovascular outcomes in diabetic patients

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Abstract

Background

Metabolic abnormalities such as dyslipidemia, glucose and high blood pressure are common in diabetic patients. Visit-to-visit variabilities in these measures have been reported as potential residual cardiovascular risk factors. However, the relationship between these variabilities and their effects on cardiovascular prognosis have not been studied.

Methods

A total of 22,310 diabetic patients with ≥ 3 measurements of systolic blood pressure (SBP), blood glucose, total cholesterol (TC), and triglyceride (TG) levels during a minimum of three years at three tertiary general hospitals were selected. They were divided into high/low variability groups for each variable based on the coefficient of variation (CV) values. The primary outcome was the incidence of major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, and stroke.

Results

All high CV groups had a higher incidence of MACE than those with low CV (6.0% vs. 2.5% for SBP-CV groups, 5.5% vs. 3.0% for TC-CV groups, 4.7% vs. 3.8% for TG-CV groups, 5.8% vs. 2.7% for glucose-CV groups). In multivariable Cox regression analysis,, high SBP-CV (HR 1.79 [95% CI 1.54–2.07], p < 0.01), high TC-CV (HR 1.54 [95% CI 1.34–1.77], p < 0.01), high TG-CV (HR 1.15 [95% CI 1.01–1.31], p = 0.040) and high glucose-CV (HR 1.61 [95% CI 1.40–1.86], p < 0.01) were independent predictors of MACE.

Conclusion

Variability of SBP, TC, TG and glucose are important residual risk factors for cardiovascular events in diabetic patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12933-023-01848-x.

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Most cited references 29

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SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe

Stephan Achenbach, Krasimira Aleksandrova, Pilar Amiano … (2021)

Aims The aim of this study was to develop, validate, and illustrate an updated prediction model (SCORE2) to estimate 10-year fatal and non-fatal cardiovascular disease (CVD) risk in individuals without previous CVD or diabetes aged 40–69 years in Europe. Methods and results We derived risk prediction models using individual-participant data from 45 cohorts in 13 countries (677 684 individuals, 30 121 CVD events). We used sex-specific and competing risk-adjusted models, including age, smoking status, systolic blood pressure, and total- and HDL-cholesterol. We defined four risk regions in Europe according to country-specific CVD mortality, recalibrating models to each region using expected incidences and risk factor distributions. Region-specific incidence was estimated using CVD mortality and incidence data on 10 776 466 individuals. For external validation, we analysed data from 25 additional cohorts in 15 European countries (1 133 181 individuals, 43 492 CVD events). After applying the derived risk prediction models to external validation cohorts, C-indices ranged from 0.67 (0.65–0.68) to 0.81 (0.76–0.86). Predicted CVD risk varied several-fold across European regions. For example, the estimated 10-year CVD risk for a 50-year-old smoker, with a systolic blood pressure of 140 mmHg, total cholesterol of 5.5 mmol/L, and HDL-cholesterol of 1.3 mmol/L, ranged from 5.9% for men in low-risk countries to 14.0% for men in very high-risk countries, and from 4.2% for women in low-risk countries to 13.7% for women in very high-risk countries. Conclusion SCORE2—a new algorithm derived, calibrated, and validated to predict 10-year risk of first-onset CVD in European populations—enhances the identification of individuals at higher risk of developing CVD across Europe.

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Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension.

Peter M. Rothwell, Sally Howard, Eamon Dolan … (2010)

The mechanisms by which hypertension causes vascular events are unclear. Guidelines for diagnosis and treatment focus only on underlying mean blood pressure. We aimed to reliably establish the prognostic significance of visit-to-visit variability in blood pressure, maximum blood pressure reached, untreated episodic hypertension, and residual variability in treated patients. We determined the risk of stroke in relation to visit-to-visit variability in blood pressure (expressed as standard deviation [SD] and parameters independent of mean blood pressure) and maximum blood pressure in patients with previous transient ischaemic attack (TIA; UK-TIA trial and three validation cohorts) and in patients with treated hypertension (Anglo-Scandinavian Cardiac Outcomes Trial Blood Pressure Lowering Arm [ASCOT-BPLA]). In ASCOT-BPLA, 24-h ambulatory blood-pressure monitoring (ABPM) was also studied. In each TIA cohort, visit-to-visit variability in systolic blood pressure (SBP) was a strong predictor of subsequent stroke (eg, top-decile hazard ratio [HR] for SD SBP over seven visits in UK-TIA trial: 6.22, 95% CI 4.16-9.29, p<0.0001), independent of mean SBP, but dependent on precision of measurement (top-decile HR over ten visits: 12.08, 7.40-19.72, p<0.0001). Maximum SBP reached was also a strong predictor of stroke (HR for top-decile over seven visits: 15.01, 6.56-34.38, p<0.0001, after adjustment for mean SBP). In ASCOT-BPLA, residual visit-to-visit variability in SBP on treatment was also a strong predictor of stroke and coronary events (eg, top-decile HR for stroke: 3.25, 2.32-4.54, p<0.0001), independent of mean SBP in clinic or on ABPM. Variability on ABPM was a weaker predictor, but all measures of variability were most predictive in younger patients and at lower (

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Intensive lipid lowering with atorvastatin in patients with stable coronary disease.

John C. LaRosa, Scott M. Grundy, David D. Waters … (2005)

Previous trials have demonstrated that lowering low-density lipoprotein (LDL) cholesterol levels below currently recommended levels is beneficial in patients with acute coronary syndromes. We prospectively assessed the efficacy and safety of lowering LDL cholesterol levels below 100 mg per deciliter (2.6 mmol per liter) in patients with stable coronary heart disease (CHD). A total of 10,001 patients with clinically evident CHD and LDL cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) were randomly assigned to double-blind therapy and received either 10 mg or 80 mg of atorvastatin per day. Patients were followed for a median of 4.9 years. The primary end point was the occurrence of a first major cardiovascular event, defined as death from CHD, nonfatal non-procedure-related myocardial infarction, resuscitation after cardiac arrest, or fatal or nonfatal stroke. The mean LDL cholesterol levels were 77 mg per deciliter (2.0 mmol per liter) during treatment with 80 mg of atorvastatin and 101 mg per deciliter (2.6 mmol per liter) during treatment with 10 mg of atorvastatin. The incidence of persistent elevations in liver aminotransferase levels was 0.2 percent in the group given 10 mg of atorvastatin and 1.2 percent in the group given 80 mg of atorvastatin (P<0.001). A primary event occurred in 434 patients (8.7 percent) receiving 80 mg of atorvastatin, as compared with 548 patients (10.9 percent) receiving 10 mg of atorvastatin, representing an absolute reduction in the rate of major cardiovascular events of 2.2 percent and a 22 percent relative reduction in risk (hazard ratio, 0.78; 95 percent confidence interval, 0.69 to 0.89; P<0.001). There was no difference between the two treatment groups in overall mortality. Intensive lipid-lowering therapy with 80 mg of atorvastatin per day in patients with stable CHD provides significant clinical benefit beyond that afforded by treatment with 10 mg of atorvastatin per day. This occurred with a greater incidence of elevated aminotransferase levels. Copyright 2005 Massachusetts Medical Society.

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Author and article information

Contributors

Hyung Joon Joo: drjoohj@korea.ac.kr

Journal

Journal ID (nlm-ta): Cardiovasc Diabetol

Journal ID (iso-abbrev): Cardiovasc Diabetol

Title: Cardiovascular Diabetology

Publisher: BioMed Central (London )

ISSN (Electronic): 1475-2840

Publication date (Electronic): 15 May 2023

Publication date PMC-release: 15 May 2023

Publication date Collection: 2023

Volume: 22

Electronic Location Identifier: 114

Affiliations

[1 ]GRID grid.411134.2, ISNI 0000 0004 0474 0479, Division of Cardiology, Department of Internal Medicine, , Korea University Anam Hospital, ; Seoul, Korea

[2 ]GRID grid.222754.4, ISNI 0000 0001 0840 2678, Department of Biostatistics, , Korea University College of Medicine, ; Seoul, Korea

[3 ]GRID grid.411134.2, ISNI 0000 0004 0474 0479, Division of Cardiology, Department of Internal Medicine, , Korea University Ansan Hospital, ; Ansan, Korea

[4 ]GRID grid.411134.2, ISNI 0000 0004 0474 0479, Division of Cardiology, Department of Internal Medicine, , Korea University Guro Hospital, ; Seoul, Korea

[5 ]GRID grid.411134.2, ISNI 0000 0004 0474 0479, Department of Cardiology, Cardiovascular Center, , Korea University Anam Hospital, University College of Medicine, ; 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 Korea

[6 ]GRID grid.222754.4, ISNI 0000 0001 0840 2678, Korea University Research Institute for Medical Bigdata Science, , College of Medicine, Korea University, ; Seoul, Korea

Article

Publisher ID: 1848

DOI: 10.1186/s12933-023-01848-x

PMC ID: 10186656

PubMed ID: 37189113

SO-VID: 318f8396-74f3-416c-97e4-51a8f19e0528

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 13 March 2023

Date accepted : 4 May 2023

Funding

Funded by: MSIT(Ministry of Science and ICT), Korea, under the ICAN(ICT Challenge and Advanced Network of HRD) program

Award ID: IITP-2022-RS-2022-00156439

Funded by: Medical data-driven hospital support project through the Korea Health Information Service(KHIS), funded by the Ministry of Health & Welfare

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ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: metabolic variability,diabetes mellitus,blood pressure,lipid profile

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ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: metabolic variability, diabetes mellitus, blood pressure, lipid profile

Effects of metabolic parameters’ variability on cardiovascular outcomes in diabetic patients

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Abstract

Background

Methods

Results

Conclusion

Supplementary Information

Related collections

Journal of the ASEAN Federation of Endocrine Societies

Most cited references 29

SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe

Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension.

Intensive lipid lowering with atorvastatin in patients with stable coronary disease.

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