Type 2 diabetes: basic clinical and laboratory parameters and risk of cardiovascular death

Aim. To evaluate the basic clinical and laboratory parameters and their relationship with the 14-year risk of cardiovascular death in individuals with type 2 diabetes (T2D).

Material and methods. A prospective case-control study of a sample of Novosibirsk residents with T2D was performed. An initial examination was conducted as part of the HAPIEE project in 2003-2005. The follow-up period lasted until 2017 and amounted to 13,7±0,7 years. The case group consisted of 145 people (mean age — 62,0±5,7 years) with recorded cardiovascular death. Control group — 272 people (mean age — 57,9±6,6 years) without recorded death as of December 31, 2017. Persons with a history of non-fatal myocardial infarction and/or stroke at the initial examination were excluded. Blood pressure (BP), biochemical, anthropometric and socio-demographic data were determined. Logistic regression models were used to analyze the association of clinical and laboratory parameters with the risk of cardiovascular death.

Results. T2D subjects with recorded cardiovascular death at the initial examination had a longer duration of the disease, higher fasting plasma glucose (FPG) and anthropometric parameters (body mass index (BMI), waist circumference (WC) (in  women)), systolic blood pressure (SBP) and diastolic blood pressure (DBP). In individuals of both sexes, the risk of cardiovascular death increased 2,2 times with WC >95 cm, 2,3 times with an increased WC/HC ratio, 2,2 times with a BMI ≥30 kg/m², 1,9 times with physical activity <3 hours/week, 2 times for smokers and those with a single marital status, 3,5 times for hypertensive people, 2 times with FPG ≥7,5 mmol/L and longer duration of diabetes.

Conclusion. Fourteen-year follow-up revealed that individuals with T2D have associations of cardiovascular death with both conventional risk factors such as hypertension, abdominal obesity, low level of physical activity, smoking, single marital status, and diabetes-related ones — FPG and the duration of diabetes.

1. Dedov II, Shestakova MV, Vikulova OK, et al. Atlas of Diabetes Register in Russian Federation, status 2018. Diabetes mellitus. 2019;22(2S):4-61. (In Russ.) doi:10.14341/DM12208.

2. Peasey A, Bobak M, Kubinova R, et al. Determinants of cardiovascular disease and other non-communicable diseases in Central and Eastern Europe: Rationale and design of the HAPIEE study. BMC Public Health. 2006;18(6):255-65. doi:10.1186/1471-2458-6-255.

3. Stevens RJ, Kothari V, Adler AI, et al. The UKPDS Risk Engine: a model for the risk of coronary heart disease in type II diabetes (UKPDS 56). Clin Sci (Lond) 2002 Jun;102(6):679.

4. D’Agostino RB, Sr Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117(6):743-53. doi:10.1161/CIRCULATIONAHA.107.699579.

5. Simonova GI, Mustafina SV, Nikitin YP, et al. Waist circumference as indicator components of metabolic syndrome in the siberian population. Bulletin of Siberian Medicine. 2014;13(2):88-94. (In Russ.) doi:10.20538/1682-0363-2014-2-88-94.

6. Qin R, Chen T, Lou Q, et al. Excess risk of mortality and cardiovascular events associated with smoking among patients with diabetes: meta-analysis of observational prospective studies. Int J Cardiol. 2013 Jul 31;167(2):342-50. doi:10.1016/j.ijcard.2011.12.100.

7. Cushman WC, Evans GW, Byington RP, et al. ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. NEngl J Med. 2010;362:1575-85. doi:10.1056/NEJMoa1001286.

8. Dedov II, Shestakova MV, Mayorov AU. Algorithms of Specialized Medical Care for Diabetes Mellitus Patients. Edited by (9th edition) Diabetes mellitus. 2019. (In Russ.) ISBN 978-5-91487-136-6, doi: 10.14341/DM221S1.

9. Malyutina SK, Simonova GI, Gafarov VV. Cohort analysis of conventional risk factors impact on the risk of cardiovascular diseases in Novosibirsk population. In. Monitoring of cardiovascular incidence, mortality and their risk factors in different regions of the world (WHO MONICA project) in two volumes. Ed. Y.P. Nikitin. Novosibirsk: Academic Publishing House “Geo”. 2016;293-313. (In Russ.) ISBN 978-5-9907634-6-3.

10. Brunström M, Carlberg B. Effect of anti-hypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses. BMJ. 2016;352:i717. doi:10.1136/bmj.i717.

11. McBrien K, Rabi DM, Campbell N, et al. Intensive and standard blood pressure target sin patients with type 2 diabetes mellitus: systematic review and meta-analysis. Arch Intern Med. 2012;172:1296-303. doi:10.1001/archinternmed.2012.3147.

12. Lee JS, Chang PY, Zhang Y. Triglyceride and HDL-C Dyslipidemia and Risks of Coronary Heart Disease and Ischemic Stroke by Glycemic Dysregulation Status: The Strong Heart Study. Diabetes Care. 2017 Apr;40(4):529-37. doi:10.2337/dc16-1958.

13. Sattar N, Rawshani A, Franzén S. Age at Diagnosis of Type 2 Diabetes Mellitus and Associations With Cardiovascular and Mortality Risks. Circulation. 2019 May 7;139(19):2228-37. doi:10.1161/CIRCULATIONAHA.118.037885.

14. Mustafina SV, Simonova GI, Rymar OD, et al. Comparative characteristics of diabetes risk scores. Diabetes mellitus. 2014;17(3):17-22. (In Russ.) doi:10.14341/DM2014317-22.

15. Mustafina SV, Rymar OD, Sazonova OV, et al. Validation of the Finnish diabetes risk score (FINDRISC) for the Caucasian population of Siberia. Diabetes mellitus 2016;19(2):113-8. (In Russ.) doi:10.14341/DM200418-10.