Impact of type 2 diabetes and microvascular complications on mortality and cardiovascular outcomes in a multiethnic Asian population

Abstract

IntroductionDiabetes mellitus is a growing public health epidemic in Asia. We examined the impact of type 2 diabetes, glycemic control and microvascular complications on mortality and cardiovascular outcomes in a multiethnic population-based cohort of Asians without prior cardiovascular disease.Research design and methodsThis was a prospective population-based cohort study in Singapore comprising participants from the three major Asian ethnic groups: Chinese, Malays and Indians, with baseline examination in 2004–2011. Participants with type 1 diabetes and those with cardiovascular disease at baseline were excluded. Type 2 diabetes, Hemoglobin A1c (HbA1c) levels and presence of microvascular complications (diabetic retinopathy and nephropathy) were defined at baseline. The primary outcome was all-cause mortality and major adverse cardiovascular events (MACEs), defined as a composite of cardiovascular mortality, myocardial infarction, stroke and revascularization, collected using a national registry.ResultsA total of 8541 subjects were included, of which 1890 had type 2 diabetes at baseline. Subjects were followed for a median of 6.4 (IQR 4.8–8.8) years. Diabetes was a significant predictor of mortality (adjusted HR 1.74, 95% CI 1.45 to 2.08, p<0.001) and MACE (adjusted HR 1.64, 95% CI 1.39 to 1.93, p<0.001). In those with diabetes, higher HbA1c levels were associated with increased MACE rates (adjusted HR (per 1% increase) 1.18, 95% CI 1.11 to 1.26, p<0.001) but not mortality (p=0.115). Subjects with two microvascular complications had significantly higher mortality and MACE compared with those with only either microvascular complication (adjusted p<0.05) and no microvascular complication (adjusted p<0.05).ConclusionDiabetes is a significant predictor of mortality and cardiovascular morbidity in Asian patients without prior cardiovascular disease. Among patients with type 2 diabetes, poorer glycemic control was associated with increased MACE but not mortality rates. Greater burden of microvascular complications identified a subset of patients with poorer outcomes.

Association of retinopathy with risk of all-cause and specific-cause mortality in the National Health and Nutrition Examination Survey, 2005 to 2008

“…( 16 ) In addition, the results of the severity analysis similarly confirmed that all grades of retinopathy were significant associated with DM-specific causes of death, and the trend test was also significant ( P for trend <0.05), the DM-specific HR increased exponentially with increasing retinopathy severity, and patients with PR had the highest risk of DM-specific death (HR = 13.62, 95% CI: 2.52–73.75). As for the reasons why grading of retinopathy was associated with the trend of increased DM-specific mortality risk, the results of a multi-ethnic Asian population study showed that survival rates of DM patients without microvascular disease were similar to those of non-DM patients after approximately 7 years, ( 48 ) suggesting that the lesion burden of the microvasculature in DM patients predicts an increased mortality risk. As previously described, the retina is the only site where blood vessels are directly visible, and the grading of retinopathy obtained by fundus photography may be an indicator of systemic microvascular disease characteristics, which could explain the fact that increased severity of retinopathy leads to an exponential increase in the DM-specific mortality risk.…”

Plasma Ceramides as Biomarkers for Microvascular Disease in Diabetes: Evaluating the Relationship Between Ceramide and Multiple Outcomes

“…The microcirculation is emerging as a major determinant of cardiovascular outcomes among patients with and without DM (19). This study aimed to ll this gap and evaluate the effectiveness of using ceramide as a biomarker for microvascular disease.…”

High neutrophil to lymphocyte ratio with type 2 diabetes mellitus predicts poor prognosis in patients undergoing percutaneous coronary intervention: a large-scale cohort study

“…First, high NLR values promoted the development and acceleration of diabetic microvascular complications, including diabetic retinopathy, nephropathy, and peripheral neuropathy [ 46 , 47 ]. Patients with increasing burden of microvascular complications were at risk for higher mortality and poorer cardiovascular outcomes [ 48 ]. Second, hyperglycemia with increased NLR was related to increased complexity and severity of coronary lesions [ 49 ].…”