Trajectories of metabolic risk factors prior to the onset of cardiovascular disease in patients with newly diagnosed diabetes

Objectives

Many studies have demonstrated that multiple metabolic risk factors (MRFs) predict cardiovascular disease (CVD) in patients with diabetes, but changes in these markers before CVD onset are not well characterized. We aimed to explore the trajectories of various MRFs before the occurrence of CVD in patients with newly diagnosed diabetes.

Study design

Prospective cohort study.

Methods

We selected 21,798 patients with newly diagnosed diabetes from seven cycles in the Kailuan cohort. MRFs were measured at two-year intervals prior to CVD diagnosis. We used the mixed effects models to construct trajectories for 16 MRFs respectively.

Results

During up to 15 years of follow-up, a total of 2,105 CVD events occurred. Participants who developed CVD had more adverse levels of most MRFs at baseline and during follow-up than those who did not develop CVD. Before CVD diagnosis, fasting plasma glucose, insulin resistance, pulse pressure, heart rate, liver function, and inflammatory biomarkers showed linear increases, while insulin sensitivity, lipids profiles, obesity indices, and diastolic blood pressure showed linear decreases. Systolic blood pressure, as one of the most important components in predicting CVD, showed a quadratic increase.

Conclusions

In patients with newly diagnosed diabetes, unfavorable levels of MRFs were present before CVD developed. Key MRFs, including the TyG index, VAI, SBP, and pulse pressure, progressively increased over time and remained higher compared to non-CVD populations. This highlights the need for early prevention to reduce the burden of cardiovascular complications in diabetes.