Department of Internal Medicine, School of Medicine, University Hospital Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rua Croton, 72 Jacarepagua, Rio de Janeiro, RJ, CEP: 22750-240, Brasil.
Cardiovasc Diabetol. 2022 May 14;21(1):76. doi: 10.1186/s12933-022-01514-8.
The prognostic importance of changes in aortic stiffness for the occurrence of adverse cardiovascular outcomes and mortality has never been investigated in patients with type 2 diabetes. We aimed to evaluate it in a cohort of 417 patients.
Changes in aortic stiffness were assessed by 2 carotid-femoral pulse wave velocity (CF-PWV) measurements performed over a 4-year period. Multivariable Cox analysis examined the associations between changes in CF-PWV, evaluated as a continuous variable with splines and as categorical ones (quartiles and stable/reduction/increase subgroups), and the occurrence of total cardiovascular events (CVEs), major adverse CVEs (MACEs), and all-cause and cardiovascular mortality.
Over a median follow-up of 8.2 years after the 2nd CF-PWV measurement, there were 101 total CVEs (85 MACEs) and 135 all-cause deaths (64 cardiovascular). As a continuous variable, the lowest risk nadir was at -2.5%/year of CF-PWV change, with significantly higher risks of mortality associated with CF-PWV increases, but no excess risks at extremes of CF-PWV reduction. Otherwise, in categorical analyses, patients in the 1st quartile (greatest CF-PWV reductions) had excess risks of all-cause and cardiovascular mortality (hazard ratios [HRs]: 2.0-2.7), whereas patients in 3rd quartile had higher risks of all outcomes (HRs: 2.0-3.2), in relation to the lowest risk 2nd quartile subgroup. Patients in the 4th quartile had higher risks of all-cause mortality. Categorization as stable/reduction/increase subgroups was confirmatory, with higher risks at greater reductions (HRs: 1.7-3.3) and at greater increases in CF-PWV (HRs: 1.9-3.4), in relation to those with stable CF-PWV.
Changes in aortic stiffness, mainly increases and possibly also extreme reductions, are predictors of adverse cardiovascular outcomes and mortality in individuals with type 2 diabetes.
主动脉僵硬度的变化对 2 型糖尿病患者不良心血管结局和死亡率的预后意义从未被研究过。我们旨在 417 例患者的队列中评估它。
通过在 4 年内进行 2 次颈股脉搏波速度（CF-PWV）测量来评估主动脉僵硬度的变化。多变量 Cox 分析检查了 CF-PWV 变化与总心血管事件（CVE）、主要不良 CVE（MACE）以及全因和心血管死亡率之间的关联，CF-PWV 变化作为连续变量用样条和分类变量（四分位数和稳定/减少/增加亚组）进行评估。
在第 2 次 CF-PWV 测量后的中位随访 8.2 年内，发生了 101 例总 CVE（85 例 MACE）和 135 例全因死亡（64 例心血管）。作为一个连续变量，CF-PWV 变化的最低风险低谷为-2.5%/年，死亡率的风险显著升高与 CF-PWV 的增加相关，但 CF-PWV 减少的极端值没有多余的风险。否则，在分类分析中，第 1 四分位数（最大的 CF-PWV 减少）的患者有全因和心血管死亡的超额风险（危险比[HR]：2.0-2.7），而第 3 四分位数的患者有更高的所有结局风险（HR：2.0-3.2），与最低风险的第 2 四分位亚组相比。第 4 四分位数的患者有更高的全因死亡率风险。稳定/减少/增加亚组的分类是确认性的，在更大的减少（HR：1.7-3.3）和更大的 CF-PWV 增加（HR：1.9-3.4）中风险更高，与稳定 CF-PWV 的患者相比。
主动脉僵硬度的变化，主要是增加和可能的极端减少，是 2 型糖尿病患者不良心血管结局和死亡率的预测因素。
