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Metabolically "extremely unhealthy" obese and non-obese people with diabetes and the risk of cardiovascular adverse events: the Silesia Diabetes - Heart Project.
- Source :
-
Cardiovascular diabetology [Cardiovasc Diabetol] 2024 Sep 03; Vol. 23 (1), pp. 326. Date of Electronic Publication: 2024 Sep 03. - Publication Year :
- 2024
-
Abstract
- Background: There is a growing burden of non-obese people with diabetes mellitus (DM). However, their cardiovascular risk (CV), especially in the presence of cardiovascular-kidney-metabolic (CKM) comorbidities is poorly characterised. The aim of this study was to analyse the risk of major CV adverse events in people with DM according to the presence of obesity and comorbidities (hypertension, chronic kidney disease, and dyslipidaemia).<br />Methods: We analysed persons who were enrolled in the prospective Silesia Diabetes Heart Project (NCT05626413). Individuals were divided into 6 categories according to the presence of different clinical risk factors (obesity and CKM comorbidities): (i) Group 1: non-obese with 0 CKM comorbidities; (ii) Group 2: non-obese with 1-2 CKM comorbidities; (iii) Group 3: non-obese with 3 CKM comorbidities (non-obese "extremely unhealthy"); (iv) Group 4: obese with 0 CKM comorbidities; (v) Group 5: obese with 1-2 CKM comorbidities; and (vi) Group 6: obese with 3 CKM comorbidities (obese "extremely unhealthy"). The primary outcome was a composite of CV death, myocardial infarction (MI), new onset of heart failure (HF), and ischemic stroke.<br />Results: 2105 people with DM were included [median age 60 (IQR 45-70), 48.8% females]. Both Group 1 and Group 6 were associated with a higher risk of events of the primary composite outcome (aHR 4.50, 95% CI 1.20-16.88; and aHR 3.78, 95% CI 1.06-13.47, respectively). On interaction analysis, in "extremely unhealthy" persons the impact of CKM comorbidities in determining the risk of adverse events was consistent in obese and non-obese ones (P <subscript>int</subscript> =0.824), but more pronounced in individuals aged < 65 years compared to older adults (P <subscript>int</subscript> = 0.028).<br />Conclusion: Both non-obese and obese people with DM and 3 associated CKM comorbidities represent an "extremely unhealthy" phenotype which are at the highest risk of CV adverse events. These results highlight the importance of risk stratification of people with DM for risk factor management utilising an interdisciplinary approach.<br /> (© 2024. The Author(s).)
- Subjects :
- Humans
Female
Male
Middle Aged
Aged
Risk Assessment
Prospective Studies
Time Factors
Renal Insufficiency, Chronic diagnosis
Renal Insufficiency, Chronic epidemiology
Renal Insufficiency, Chronic mortality
Dyslipidemias epidemiology
Dyslipidemias diagnosis
Dyslipidemias blood
Hypertension epidemiology
Hypertension diagnosis
Hypertension mortality
Italy epidemiology
Prognosis
Risk Factors
Heart Disease Risk Factors
Obesity epidemiology
Obesity diagnosis
Obesity mortality
Comorbidity
Cardiovascular Diseases epidemiology
Cardiovascular Diseases diagnosis
Cardiovascular Diseases mortality
Diabetes Mellitus epidemiology
Diabetes Mellitus diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1475-2840
- Volume :
- 23
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Cardiovascular diabetology
- Publication Type :
- Academic Journal
- Accession number :
- 39227929
- Full Text :
- https://doi.org/10.1186/s12933-024-02420-x