The Association Between Diabetes and Hypertension Time Course, Their Cumulative CoExposure, and PostCoronary Artery Bypass Graft Outcomes.

Abstract

Background: The association between patient outcomes and cumulative effects of cardiovascular risk factors over time is recognized but poorly quantified. This study quantitatively addressed the impact of diabetes and hypertension duration, and their combined effect, on postcoronary artery bypass grafting (CABG) outcomes.

Methods: This single-center cohort study included patients who underwent coronary angiography followed by isolated CABG (n = 10,803, median follow-up: 111.3 months) from 2007 to 2017. Study outcomes comprised all-cause mortality and major adverse cardio-cerebrovascular events (MACCE). Cox regressions were used to assess the association between risk factors' duration (<5 years, 5-10 years, ≥10 years) and study outcomes among the total cohort and stratified by the copresence of risk factors.

Results: The study population aged 65.56 ± 10.00 years (75.3% male, 40.1% diabetes, and 64.1% hypertension). The risk of study outcomes increased with increasing duration of diabetes (adjusted-hazard ratio from "0-5y" to "≥10y" group for all-cause mortality: 1.37 (95% CI: 1.23-1.52) to 1.91 (1.69-2.16), and for MACCE: 1.23 (1.14-1.34) to 1.59 (1.44-1.76)). When stratified by hypertension status, the association between shorter diabetes duration and study outcomes became nonsignificant among nonhypertensive patients, while the association persisted for their hypertensive counterparts (reference group: nondiabetic patients). An increasing risk pattern was observed with longer hypertension duration (from 1.38 (1.25-1.53) to 1.51 (1.30-1.75) for all-cause mortality and 1.27 (1.18-1.37) to 1.39 (1.24-1.55) for MACCE). This risk enhancement was more pronounced when diabetes coexisted.

Conclusions: Our results highlight the significance of risk factor exposure duration in patient risk assessment. These insights could be valuable for enhancing existing risk assessment tools and developing tailored preventive strategies.