Jan F. de Leijer, Frank L. J. Visseren, Birgitta K. Velthuis, Ynte M. Ruigrok, Jaco J.M. Zwanenburg, Manon G. van der Meer, Martin Teraa, Pim A. de Jong, Thomas T. van Sloten, the UCC-SMART study group
{"title":"伴有和不伴有2型糖尿病的明显心血管疾病患者的动脉硬化和动脉粥样硬化、心血管事件和全因死亡率","authors":"Jan F. de Leijer, Frank L. J. Visseren, Birgitta K. Velthuis, Ynte M. Ruigrok, Jaco J.M. Zwanenburg, Manon G. van der Meer, Martin Teraa, Pim A. de Jong, Thomas T. van Sloten, the UCC-SMART study group","doi":"10.1111/dme.70067","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>It is unclear if arterial stiffness and atherosclerosis are differentially related to cardiovascular events and mortality in individuals with manifest cardiovascular disease with and without type 2 diabetes (T2DM) and to what extent they mediate the relation between T2DM and these outcomes.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Prospective data were used from the UCC-SMART cohort, including individuals with manifest cardiovascular disease (<i>n</i> = 9465). Arterial stiffness (brachial pulse pressure and carotid artery distensibility coefficient (DC)) and atherosclerosis (presence of carotid plaque and ankle-brachial index <0.9) were determined. Cardiovascular events included non-fatal stroke, non-fatal myocardial infarction and cardiovascular death. Cox regression and structural equation models were used with adjustment for confounders.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Over a median follow-up of 10.3 years, 2087 cardiovascular events and 2808 deaths occurred. Higher brachial pulse pressure was related to cardiovascular events and mortality in individuals with T2DM and without T2DM (HRs ≥ 1.09; 95% confidence intervals (CIs) between 1.03 and 1.30). Lower carotid artery DC was related to mortality in individuals with T2DM and without T2DM (hazard ratios (HRs) ≥ 1.20; 95% CI between 1.00 and 1.48), but only related to cardiovascular events in individuals without T2DM (HR 1.34; 95% CI between 1.20 and 1.49). Carotid and lower extremity atherosclerosis were both related to cardiovascular events and mortality in individuals with T2DM and without T2DM (HRs ≥ 1.52; 95% CI between 1.27 and 2.21). Up to 8.1% and 16.3% of the relation between T2DM and outcomes was mediated through arterial stiffness and atherosclerosis, respectively.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Arterial stiffness and atherosclerosis are independently, but not differentially, related to cardiovascular events and mortality in individuals with manifest cardiovascular disease with and without T2DM. Atherosclerosis explained a larger proportion of the relation between T2DM and outcomes.</p>\n </section>\n </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 9","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.70067","citationCount":"0","resultStr":"{\"title\":\"Arterial stiffness and atherosclerosis and incident cardiovascular events and all-cause mortality in individuals with manifest cardiovascular disease with and without type 2 diabetes\",\"authors\":\"Jan F. de Leijer, Frank L. J. Visseren, Birgitta K. Velthuis, Ynte M. Ruigrok, Jaco J.M. Zwanenburg, Manon G. van der Meer, Martin Teraa, Pim A. de Jong, Thomas T. van Sloten, the UCC-SMART study group\",\"doi\":\"10.1111/dme.70067\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>It is unclear if arterial stiffness and atherosclerosis are differentially related to cardiovascular events and mortality in individuals with manifest cardiovascular disease with and without type 2 diabetes (T2DM) and to what extent they mediate the relation between T2DM and these outcomes.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Prospective data were used from the UCC-SMART cohort, including individuals with manifest cardiovascular disease (<i>n</i> = 9465). Arterial stiffness (brachial pulse pressure and carotid artery distensibility coefficient (DC)) and atherosclerosis (presence of carotid plaque and ankle-brachial index <0.9) were determined. Cardiovascular events included non-fatal stroke, non-fatal myocardial infarction and cardiovascular death. Cox regression and structural equation models were used with adjustment for confounders.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Over a median follow-up of 10.3 years, 2087 cardiovascular events and 2808 deaths occurred. Higher brachial pulse pressure was related to cardiovascular events and mortality in individuals with T2DM and without T2DM (HRs ≥ 1.09; 95% confidence intervals (CIs) between 1.03 and 1.30). Lower carotid artery DC was related to mortality in individuals with T2DM and without T2DM (hazard ratios (HRs) ≥ 1.20; 95% CI between 1.00 and 1.48), but only related to cardiovascular events in individuals without T2DM (HR 1.34; 95% CI between 1.20 and 1.49). Carotid and lower extremity atherosclerosis were both related to cardiovascular events and mortality in individuals with T2DM and without T2DM (HRs ≥ 1.52; 95% CI between 1.27 and 2.21). Up to 8.1% and 16.3% of the relation between T2DM and outcomes was mediated through arterial stiffness and atherosclerosis, respectively.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Arterial stiffness and atherosclerosis are independently, but not differentially, related to cardiovascular events and mortality in individuals with manifest cardiovascular disease with and without T2DM. 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Arterial stiffness and atherosclerosis and incident cardiovascular events and all-cause mortality in individuals with manifest cardiovascular disease with and without type 2 diabetes
Background
It is unclear if arterial stiffness and atherosclerosis are differentially related to cardiovascular events and mortality in individuals with manifest cardiovascular disease with and without type 2 diabetes (T2DM) and to what extent they mediate the relation between T2DM and these outcomes.
Methods
Prospective data were used from the UCC-SMART cohort, including individuals with manifest cardiovascular disease (n = 9465). Arterial stiffness (brachial pulse pressure and carotid artery distensibility coefficient (DC)) and atherosclerosis (presence of carotid plaque and ankle-brachial index <0.9) were determined. Cardiovascular events included non-fatal stroke, non-fatal myocardial infarction and cardiovascular death. Cox regression and structural equation models were used with adjustment for confounders.
Results
Over a median follow-up of 10.3 years, 2087 cardiovascular events and 2808 deaths occurred. Higher brachial pulse pressure was related to cardiovascular events and mortality in individuals with T2DM and without T2DM (HRs ≥ 1.09; 95% confidence intervals (CIs) between 1.03 and 1.30). Lower carotid artery DC was related to mortality in individuals with T2DM and without T2DM (hazard ratios (HRs) ≥ 1.20; 95% CI between 1.00 and 1.48), but only related to cardiovascular events in individuals without T2DM (HR 1.34; 95% CI between 1.20 and 1.49). Carotid and lower extremity atherosclerosis were both related to cardiovascular events and mortality in individuals with T2DM and without T2DM (HRs ≥ 1.52; 95% CI between 1.27 and 2.21). Up to 8.1% and 16.3% of the relation between T2DM and outcomes was mediated through arterial stiffness and atherosclerosis, respectively.
Conclusion
Arterial stiffness and atherosclerosis are independently, but not differentially, related to cardiovascular events and mortality in individuals with manifest cardiovascular disease with and without T2DM. Atherosclerosis explained a larger proportion of the relation between T2DM and outcomes.
期刊介绍：
Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions.
The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed.
We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services.
Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”
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