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Diabetes, glycemic control and arterial stiffness: a real-world cohort study in the context of predictive, preventive, and personalized medicine

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Abstract

Background

Arterial stiffness is a major contributor to morbidity and mortality worldwide. Although several metabolic markers associated with arterial stiffness have been developed, there is limited data regarding whether glycemic control modifies the association between diabetes and arterial stiffness. For these reasons, identification of traits around diabetes will directly contribute to arterial stiffness and atherosclerosis management in the context of predictive, preventive, and personalized medicine (PPPM). Thus, this study aimed to explore the relationship of diabetes and glycemic control status with arterial stiffness in a real-world setting.

Methods

Data of participants from Bei**g **aotangshan Examination Center (BXEC) with at least two surveys between 2008 and 2019 were used. Cumulative hazards were presented by inverse probability of treatment weighted (IPTW) Kaplan-Meier curves. Cox models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI). Arterial stiffness was defined as brachial-ankle pulse wave velocity (baPWV) ≥1400 cm/s.

Results

Of 5837 participants, the mean baseline age was 46.5±9.3 years, including 3791 (64.9%) males. During a median follow-up of 4.0 years, 1928 (33.0%) cases of incident arterial stiffness were observed. People with diabetes at baseline had a 48.4% (HR: 1.484, 95% CI: 1.250–1.761) excessive risk of arterial stiffness. Adherence to good glycemic control attenuated the relationship between diabetes and arterial stiffness (HR: 1.264, 95% CI: 0.950–1.681); while uncontrolled diabetes was associated with the highest risk of arterial stiffness (HR: 1.629, 95% CI: 1.323–2.005). Results were consistent using IPTW algorithm and multiple imputed data.

Conclusion

Our study quantified that diabetes status is closely associated with an increased risk of arterial stiffness and supported that adherence to good glycemic control could attenuate the adverse effect of diabetes on arterial stiffness. Therefore, glucose monitoring and control is a cost-effective strategy for the predictive diagnostics, targeted prevention, patient stratification, and personalization of medical services in early vascular damages and arterial stiffness.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

PPPM:

Predictive preventive personalized medicine

baPWV:

Brachial-ankle pulse wave velocity

IPTW:

Inverse probability of treatment weighted

BXEC:

Bei**g **aotangshan Examination Center

BMI:

Body mass index

SBP:

Systolic blood pressure

DBP:

Diastolic blood pressure

MAP:

Mean arterial pressure

LDL:

Low-density lipoprotein

HDL:

High-density lipoprotein

eGFR:

Estimated glomerular filtration rate

SD:

Standard deviation

IQR:

Interquartile range

cfPWV:

Carotid femoral pulse wave velocity

OGTT:

Oral glucose tolerance test

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Funding

Our work was funded by the National Natural Science Foundation of China (82072911).

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Authors and Affiliations

  1. China-Japan Union Hospital of Jilin University, Jilin University, Changchun, China

    Cancan Cui, Te Zhang, Yitian Qi, Haikun Xu, Chen Sun, Zhenming Zhang, ** Kang

Authors
  1. Cancan Cui
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  2. Te Zhang
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  3. Yitian Qi
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  4. Jiaqi Chu
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  5. Haikun Xu
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  6. Chen Sun
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  7. Zhenming Zhang
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  8. **ngang Wang
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  9. Siqi Yue
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  10. ** Kang
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  11. Ling Fang
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Contributions

Literature search: T. Zhang, YT. Qi; Study conception and design: JQ. Chu, HK. Xu; Data collection: C. Sun and XP. Kang; Data analysis and interpretation: ZM. Zhang, XG. Wang; Manuscript writing and reviewing: CC. Cui, SQ. Yue; Study supervision: L. Fang.

Corresponding author

Correspondence to Ling Fang.

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The study was approved by the Ethics Committees of **aotangshan Hospital. All participants gave informed consent to participate before taking part.

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Cui, C., Zhang, T., Qi, Y. et al. Diabetes, glycemic control and arterial stiffness: a real-world cohort study in the context of predictive, preventive, and personalized medicine. EPMA Journal 14, 663–672 (2023). https://doi.org/10.1007/s13167-023-00347-z

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