Cardiovascular profiling in the diabetic continuum: results from the population-based Gutenberg Health Study

Published on Jun 24, 2021in Clinical Research in Cardiology5.46
· DOI :10.1007/S00392-021-01879-Y
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Abstract
To assess the prevalence of type 2 diabetes mellitus (T2DM) and prediabetes in the general population and to investigate the associated cardiovascular burden and clinical outcome. The study sample comprised 15,010 individuals aged 35–74 years of the population-based Gutenberg Health Study. Subjects were classified into euglycaemia, prediabetes and T2DM according to clinical and metabolic (HbA1c) information. The prevalence of prediabetes was 9.5% (n = 1415) and of T2DM 8.9% (n = 1316). Prediabetes and T2DM showed a significantly increased prevalence ratio (PR) for age, obesity, active smoking, dyslipidemia, and arterial hypertension compared to euglycaemia (for all, P < 0.0001). In a robust Poisson regression analysis, prediabetes was established as an independent predictor of clinically-prevalent cardiovascular disease (PRprediabetes 1.20, 95% CI 1.07–1.35, P = 0.002) and represented as a risk factor for asymptomatic cardiovascular organ damage independent of traditional risk factors (PR 1.04, 95% CI 1.01–1.08, P = 0.025). Prediabetes was associated with a 1.5-fold increased 10-year risk for cardiovascular disease compared to euglycaemia. In Cox regression analysis, prediabetes (HR 2.10, 95% CI 1.76–2.51, P < 0.0001) and T2DM (HR 4.28, 95% CI 3.73–4.92, P < 0.0001) indicated for an increased risk of death. After adjustment for age, sex and traditional cardiovascular risk factors, only T2DM (HR 1.89, 95% CI 1.63–2.20, P < 0.0001) remained independently associated with increased all-cause mortality. Besides T2DM, also prediabetes inherits a significant cardiovascular burden, which translates into poor clinical outcome and indicates the need for new concepts regarding the prevention of cardiometabolic disorders.
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References30
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#1Robert Wagner (University of Tübingen)H-Index: 41
#2Martin Heni (University of Tübingen)H-Index: 39
Last. Andreas Fritsche (University of Tübingen)H-Index: 102
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The state of intermediate hyperglycemia is indicative of elevated risk of developing type 2 diabetes1. However, the current definition of prediabetes neither reflects subphenotypes of pathophysiology of type 2 diabetes nor is predictive of future metabolic trajectories. We used partitioning on variables derived from oral glucose tolerance tests, MRI-measured body fat distribution, liver fat content and genetic risk in a cohort of extensively phenotyped individuals who are at increased risk for t...
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A prediabetic state is a major risk factor for the development of diabetes, and, because of an identical pathophysiological background of both conditions, their prevalence increases parallelly and equally fast. Long-term hyperglycemia is the main cause inducing chronic complications of diabetes, yet the range of glucose levels at which they start has not been yet unequivocally determined. The current data show that chronic microvascular complications of diabetes can be observed in patients with ...
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#2Yunlong Zhang (Guangzhou Medical University)H-Index: 4
Abstract Objective To evaluate the associations between prediabetes and the risk of all cause mortality and incident cardiovascular disease in the general population and in patients with a history of atherosclerotic cardiovascular disease. Design Updated meta-analysis. Data sources Electronic databases (PubMed, Embase, and Google Scholar) up to 25 April 2020. Review methods Prospective cohort studies or post hoc analysis of clinical trials were included for analysis if they reported adjusted rel...
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#1Yong Hoon Kim (Kangwon National University)H-Index: 13
#2Ae Young Her (Kangwon National University)H-Index: 12
Last. Yangsoo Jang (Yonsei University)H-Index: 91
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Abstract Aims We investigated the 2-year clinical outcomes of patients with acute myocardial infarction (AMI) and prediabetes after new-generation drug-eluting stents implantation. Methods A total of 11,962 patients with AMI were classified into normoglycemia (group A; 3,080), prediabetes (group B; 3,709), and diabetes (group C; 5,173) groups. The primary outcomes were the patient-oriented composite outcomes (POCOs) defined as all-cause death, recurrent myocardial infarction (Re-MI), and any rep...
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#1Kevin Luc (Jagiellonian University Medical College)H-Index: 3
#2Agata Schramm-Luc (Jagiellonian University Medical College)H-Index: 4
Last. Tomasz Mikolajczyk (Jagiellonian University Medical College)H-Index: 18
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Prediabetes is a state of elevated plasma glucose in which the threshold for diabetes has not yet been reached and can predispose to the development of type 2 diabetes and cardiovascular diseases. Insulin resistance and impaired beta-cell function are often already present in prediabetes. Hyperglycemia can upregulate markers of chronic inflammation and contribute to increased reactive oxygen species (ROS) generation, which ultimately cause vascular dysfunction. Conversely, increased oxidative st...
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Background Endothelial dysfunction is a consequence of type 2 diabetes mellitus, but it is unclear whether endothelial dysfunction of conductance versus resistance vessels may also precede type 2 d...
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#1Emma Ahlqvist (Lund University)H-Index: 28
#2Petter Storm (Lund University)H-Index: 21
Last. Leif Groop (UH: University of Helsinki)H-Index: 170
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Summary Background Diabetes is presently classified into two main forms, type 1 and type 2 diabetes, but type 2 diabetes in particular is highly heterogeneous. A refined classification could provide a powerful tool to individualise treatment regimens and identify individuals with increased risk of complications at diagnosis. Methods We did data-driven cluster analysis (k-means and hierarchical clustering) in patients with newly diagnosed diabetes (n=8980) from the Swedish All New Diabetics in Sc...
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#1Ben Brannick (UTHSC: University of Tennessee Health Science Center)H-Index: 2
#2Samuel Dagogo-Jack (UTHSC: University of Tennessee Health Science Center)H-Index: 56
Type 2 diabetes mellitus (T2DM) is one of the major causes of premature morbidity and mortality worldwide with the World Health Organization (WHO) reporting that one in ten adults worldwide had T2DM in 2014.1 In the United States, one out of every five health care dollars is spent on diabetes related healthcare.2 Diabetes Mellitus also imposes a huge drain in developing countries on national health budgets comprising on average at least 5% of their total health expenditures on diabetes in 2010.3...
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#1Yuli Huang (Southern Medical University)H-Index: 33
#2Xiaoyan Cai (Southern Medical University)H-Index: 18
Last. Yunzhao Hu (Southern Medical University)H-Index: 20
view all 5 authors...
Objectives To evaluate associations between different definitions of prediabetes and the risk of cardiovascular disease and all cause mortality. Design Meta-analysis of prospective cohort studies. Data sources Electronic databases (PubMed, Embase, and Google Scholar). Selection criteria Prospective cohort studies from general populations were included for meta-analysis if they reported adjusted relative risks with 95% confidence intervals for associations between the risk of composite cardiovasc...
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#1M. Piepoli (European Society of Cardiology)H-Index: 16
ABI : ankle–brachial (blood pressure) index ABPM : ambulatory blood pressure monitoring ACCORD : Action to Control Cardiovascular Risk in Diabetes ACE-I : angiotensin-converting enzyme inhibitor ACS : acute coronary syndromes ADVANCE : Action in Diabetes and Vascular disease: PreterAx
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#1Volker Schmitt (University of Mainz)H-Index: 14
Last. Manfred E. Beutel (University of Mainz)H-Index: 54
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Use of galectin-3 for assessing cardiac function in prediabetes and type 2 diabetes mellitus (T2DM) needs to be established. Within the Gutenberg Health Study cohort (N = 15,010, 35-74 years) patient characteristics were investigated regarding galectin-3 levels. Prognostic value of galectin-3 compared to NT-proBNP concerning cardiac function and mortality was assessed in individuals with euglycaemia, prediabetes and T2DM in 5 years follow-up. Higher galectin-3 levels related to older age, female...
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#1Volker Schmitt (University of Mainz)H-Index: 14
#2Anna-Maria Billaudelle (University of Mainz)H-Index: 1
Last. Gerrit Toenges (University of Mainz)H-Index: 9
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Background: This study sought to investigate the prevalence and clinical outcome of left ventricular (LV) geometry in prediabetes and type 2 diabetes mellitus (T2DM) and the impact of glucose metabolism on the incidence of left ventricular hypertrophy (LVH). Methods: 15,010 subjects (35–74 years) of the population-based Gutenberg Health Study were categorized into euglycemia, prediabetes, and T2DM according to clinical and metabolic (HbA1c) information. Clinical outcome was assessed via structur...
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