The association between cardiovascular outcomes and zinc deficiency among patients with type 2 diabetes: A retrospective cohort study

IF 2.6 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-08-25 DOI:10.1016/j.clnesp.2025.08.023

Yu-Min Lin , Wan-Ling Tu , Kuo-Chuan Hung , Ting-Hui Liu , Tsung Yu , Mei-Yuan Liu , Chi-Lun Tsai , Jheng-Yan Wu

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Abstract

Objective

This study aimed to investigate whether zinc deficiency (ZD) is associated with an increased risk of all-cause mortality and cardiovascular outcomes in patients with type 2 diabetes (T2D).

Methods

We conducted a retrospective cohort study using the TriNetX database. Patients aged 18 years or older with T2D and zinc measurement were included. The index date was defined as the first zinc measurement following the T2D diagnosis. Individuals were categorized into ZD (serum zinc <70 μg/dL) or control (70–120 μg/dL) groups. Propensity score matching (PSM) was employed to ensure comparability between groups. The primary outcomes were all-cause mortality and a composite of cardiovascular outcomes, including cerebrovascular complications, arrhythmia, inflammatory heart disease, ischemic heart disease, other cardiac disorders (heart failure, non-ischemic cardiomyopathy, cardiac arrest, and cardiogenic shock), and thrombotic disorders. Secondary outcomes included individual cardiovascular event. Hazard ratios (HRs) and 95 % confidence intervals (CIs) were calculated to assess outcome risks.

Results

Out of 23,041 eligible patients, 9503 had ZD and 13,538 had normal zinc levels; after PSM, 7886 patients remained in each group. Compared with the control group, the ZD group had a higher incidence rate of all-cause mortality (HR, 2.08; 95 % CI, 1.72–2.51; p < 0.001) and composite of cardiovascular outcomes (HR, 1.15; 95 % CI, 1.08–1.24; p < 0.001). The ZD group also exhibited increased rates of arrhythmia (HR, 1.20; 95 % CI, 1.10–1.32; p < 0.001), inflammatory heart disease (HR, 1.54; 95 % CI, 1.07–2.21; p < 0.001), and other cardiac disorders (HR, 1.23; 95 % CI, 1.08–1.40; p < 0.001).

Conclusion

ZD in T2D patients is associated with a significantly higher risk of all-cause mortality and cardiovascular complications. These findings underscore the potential clinical importance of monitoring and addressing zinc status in the management of patients with T2D.

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2型糖尿病患者心血管结局与缺锌之间的关系：一项回顾性队列研究

目的本研究旨在探讨锌缺乏（ZD）是否与2型糖尿病（T2D）患者全因死亡率和心血管结局风险增加有关。方法采用TriNetX数据库进行回顾性队列研究。患者年龄在18岁或以上，有T2D和锌测量。指标日期定义为T2D诊断后的第一次锌测量。将个体分为血清锌70 μg/dL组和对照组（70 - 120 μg/dL）。采用倾向得分匹配（PSM）来确保组间的可比性。主要结局是全因死亡率和心血管结局的复合，包括脑血管并发症、心律失常、炎症性心脏病、缺血性心脏病、其他心脏疾病（心力衰竭、非缺血性心肌病、心脏骤停和心源性休克）和血栓性疾病。次要结局包括个体心血管事件。计算风险比（hr）和95%置信区间（ci）来评估结果风险。结果在23,041例符合条件的患者中，9503例患有ZD， 13538例锌水平正常；经PSM治疗后，两组各有7886例患者。与对照组相比，ZD组的全因死亡率（HR, 2.08; 95% CI, 1.72-2.51; p < 0.001）和心血管综合结局发生率（HR, 1.15; 95% CI, 1.08-1.24; p < 0.001）更高。ZD组也表现出心律失常（HR, 1.20; 95% CI, 1.10-1.32; p < 0.001）、炎症性心脏病（HR, 1.54; 95% CI, 1.07-2.21; p < 0.001）和其他心脏疾病（HR, 1.23; 95% CI, 1.08-1.40; p < 0.001）的发生率增加。结论T2D患者zd与全因死亡率和心血管并发症风险显著增高相关。这些发现强调了监测和处理T2D患者锌状态的潜在临床重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.