The structure of the prevalence of cardiovascular diseases and chronic kidney disease in patients with type 2 diabetes mellitus in the stationary care


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Abstract

Type 2 diabetes mellitus (DM 2) is one of the significant risk factors for the development of cardiorenal pathology. Objective: to study the prevalence of atherosclerotic CVD (ASCVD), CKD, CHF in patients with different duration of DM 2 hospitalized for inpatient treatment, and to identify predictors of their early development and progression. Material and methods. The study included 1150 patients with DM 2 (483 males and 667 females) hospitalized in V.P. Demikhov City Clinical Hospital in the period 2020-2021. All patients underwent standard clinical, laboratory and instrumental examinations, as well as therapy correction. To assess the role of DM in the development of cardiorenal pathology, all patients were stratified into two groups according to the duration of the disease: group 1 included patients with DM 2 <5 years, group 2 included patients with DM 2 >10 years. Results. The mean age of the patients was 65 [57; 74] years, median BMI was 31,2 [26,3; 35,8] kg/m2. The mean HbA1c was 9,6 [7,9; 10,9] %, 88,6% of patients had HbA1c >7%. The median fasting blood glucose was 7,6 [6,4; 9,2] mmol/l, postprandial glucose 11,4 [9,7; 14] mmol/l. Dyslipidemia was recorded in 69,8% of study participants. Of the total number of patients with DM 2 87,6% had hypertension, 56% CHF (43,91% CHF with preserved EF, 12,09% CHF with moderately or reduced EF), 49,9% ASCVD (MI 24,7%, stroke 18,9%, diseases of the arteries of the lower extremities -17%, angina pectoris 6%). The most significant predictors of ASCVD, CKD, and CHF were age >60 years, duration of DM, hypertension and CKD. The male gender was associated with an increased chance of developing ASCVD, while the female gender was associated with CHF and CKD. Conclusion. Among the studied patients, there was a high incidence of ASCVD, CHF and CKD, regardless of the duration of DM. There was a high prevalence of the main risk factors for CVD: high levels of HbA1c, hypertension, obesity and dyslipidemia. Based on the analysis, risk factors associated with complications from the cardiovascular and renal systems in this cohort of patients were established.

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About the authors

Tatyana Yu. Demidova

N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia

Email: t.y.demidova@gmail.com
Dr. med. habil., professor, head of the Department of endocrinology of the Faculty of general medicine

Maryam Ya. Izmailova

N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia

assistant at the Department of endocrinology of the Faculty of general medicine

References

  1. Soyoye D.O., Abiodun O.O., Ikem R.T. et al. Diabetes and peripheral artery disease: A review. World J. Diabetes. 2021; 12(6): 827-38. https://dx.doi.org/10.4239/wjd. v12.i6.827.
  2. Ren H., Zhao L., Zou Y. et al. Association between atherosclerotic cardiovascular diseases risk and renal outcome in patients with type 2 diabetes mellitus. Ren Fail. 2021; 43(1): 477-87. https://dx.doi.org/10.1080/0886022X.2021.1893186.
  3. Holscher M.E., Bode C., Bugger H. Diabetic cardiomyopathy: Does the type of diabetes matter? Int J. Mol Sci. 2016; 17(12): 2136. https://dx.doi.org/10.3390/ijms17122136.
  4. ADVANCE Collaborative Group; Patel A., MacMahon S., Chalmers J. et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N. Engl J. Med. 2008; 358(24): 2560-72. https://dx.doi.org/10.1056/NEJMoa0802987.
  5. Duckworth W., Abraira C., Moritz T. et al. VADT Investigators. Glucose control and vascular complications in veterans with type 2 diabetes. N. Engl J. Med. 2009; 360(2): 129-39. https://dx.doi.org/10.1056/NEJMoa0808431.
  6. Action to Control Cardiovascular Risk in Diabetes Study Group; Gerstein H.C., Miller M.E., Byington R.P. et al. Effects of intensive glucose lowering in type 2 diabetes. N. Engl J. Med. 2008; 358(24): 2545-59. https://dx.doi.org/10.1056/NEJMoa0802743.
  7. Thiruvoipati T., Kielhorn C.E., Armstrong E.J. Peripheral artery disease in patients with diabetes: Epidemiology, mechanisms, and outcomes. World J. Diabetes 2015; 6(7): 961-69. https://dx.doi.org/10.4239/wjd.v6.i7.961.
  8. Weitz J.I., Byrne J., Clagett G.P. et al. Diagnosis and treatment of chronic arterial insufficiency of the lower extremities: A critical review. Circulation. 1996; 94(11): 3026-49. https://dx.doi.org/10.1161/01.cir.94.11.3026. Erratum in: Circulation 2000; 102(9): 1074.
  9. Navaneethan S.D., Zoungas S., Caramori M.L. et al. Diabetes management in chronic kidney disease: Synopsis of the 2020 KDIGO clinical practice guideline. Ann Intern Med. 2021; 174(3): 385-94. https://dx.doi.org/10.7326/M20-5938.
  10. Nevola R., Alfano M., Pafundi P.C. et al. Cardiorenal impact of SGLT-2 inhibitors: A conceptual revolution in the management of type 2 diabetes, heart failure and chronic kidney disease. Rev. Cardiovasc. Med. 2022; 23(3): 106. https://dx.doi.org/10.31083/j.rcm2303106.
  11. Pfeffer M.A., Shah A.M., Borlaug B.A. Heart failure with preserved ejection fraction in perspective. Circ Res. 2019; 124(11): 1598-617. https://dx.doi.org/10.1161/CIRCRESAHA.119.313572.
  12. Gede P., Lund-Andersen H., Parving H.-H., Pedersen 0. Effect of a multifactorial intervention on mortality in type 2 diabetes. N. Engl J. Med. 2008; 358(6): 580-91. https://dx.doi.org/10.1056/NEJMoa0706245.
  13. Gede P., Oellgaard J., Carstensen B. et al. Years of life gained by multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: 21 years follow-up on the steno-2 randomised trial. Diabetologia. 2016; 59(11): 2298-307. https://dx.doi.org/10.1007/s00125-016-4065-6.
  14. American Diabetes Association. Diabetes care in the hospital: Standards of medical care in diabetes-2020. Diabetes Care. 2020; 43(Suppl 1): S1-202. https://dx.doi.org/10.2337/dc20-S015.
  15. Rawshani Ai., Rawshani Ar., Franzen S. et al. Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes. N. Engl J. Med. 2018; 379(7): 633-44. https://dx.doi.org/10.1056/NEJMoa1800256.
  16. Akhtar S., Asghar N. Risk factors of cardiovascular disease in district Swat. J. Pak Med Assoc. 2015; 65(9): 1001-4.
  17. Kornelius E., Chiou J.-Y., Yang Y.-S. et al. The diabetes shared care program and risks of cardiovascular events in type 2 diabetes. Am J. Med. 2015; 128(9): 977-85. https://dx.doi.org/10.1016/j.amjmed.2015.03.025.
  18. Mahmood S.S., Levy D., Vasan R.S., Wang T.J. The Framingham Heart Study and the epidemiology of cardiovascular disease: A historical perspective. Lancet. 2014; 383(9921): 999-1008. https://dx.doi.org/10.1016/S0140-6736(13)61752-3.
  19. Ballotari P., Venturelli F., Greci M. et al. Sex differences in the effect of type 2 diabetes on major cardiovascular diseases: Results from a population-based study in Italy. Int J. Endocrinol. 2017; 2017: 6039356. https://dx.doi.org/10.1155/2017/6039356.
  20. Cheung B.M., Li C. Diabetes and hypertension: Is there a common metabolic pathway? Curr Atheroscler Rep. 2012; 14(2): 160-66. https://dx.doi.org/10.1007/s11883-012-0227-2.
  21. Ninomiya T., Kubo M., Doi Y. et al. Impact of metabolic syndrome on the development of cardiovascular disease in a general Japanese population: The Hisayama study. Stroke. 2007; 38(7): 2063-69. https://dx.doi.org/10.1161/STROKEAHA.106.479642.
  22. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998; 352(9131): 837-53.
  23. Ference B.A., Ginsberg H.N., Graham I. et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017; 38(32): 2459-72. https://dx.doi.org/10.1093/eurheartj/ehx144.
  24. Доборджгинидзе Л.М., Грацианский Н.А. Особенности диабетической дислипидемии и пути ее коррекции: эффект статинов. Проблемы эндокринологии. 2001; 47(5): 35-40. [Dobordzhginidze L.M., Gratsiansky N.A. Diabetic dyslipidemia and approaches to its correction: effect of statins. Problemy endokrinologii = Issues of Endocrinology. 2001; 47(5): 35-40 (In Russ.)]. https://dx.doi.org/10.14341/probl11683. EDN: JKURWR.
  25. Kaze A.D., Santhanam P., Musani S.K. et al. Metabolic dyslipidemia and cardiovascular outcomes in type 2 diabetes mellitus: Findings from the look AHEAD Study. J. Am Heart Assoc. 2021; 10(7): e016947. https://dx.doi.org/10.1161/JAHA.120.016947. Erratum in: J. Am Heart Assoc. 2021; 10(14): e020749.
  26. Ndumele C.E., Matsushita K., Lazo M. et al. Obesity and subtypes of incident cardiovascular disease. J. Am Heart Assoc. 2016; 5(8): e003921. https://dx.doi.org/10.1161/JAHA.116.003921.
  27. Hubert H.B., Feinleib M., McNamara P.M., Castelli W.P. Obesity as an independent risk factor for cardiovascular disease: A 26-year follow-up of participants in the Framingham Heart Study. Circulation. 1983; 67(5): 968-77. https://dx.doi.org/10.1161/01.cir.67.5.968.
  28. Wilson P.W., Bozeman S.R., Burton T.M. et al. Prediction of first events of coronary heart disease and stroke with consideration of adiposity. Circulation. 2008; 118(2): 124-30. https://dx.doi.org/10.1161/CIRCULATI0NAHA.108.772962.
  29. Morkedal B., Vatten L.J., Romundstad P.R. et al. Risk of myocardial infarction and heart failure among metabolically healthy but obese individuals: HUNT (Nord-Trondelag Health Study), Norway. J. Am Coll Cardiol. 2014; 63(11): 1071-78. https://dx.doi.org/10.1016/j.jacc.2013.11.035.
  30. Calle E.E., Thun M.J., Petrelli J.M. et al. Body-mass index and mortality in a prospective cohort of U.S. adults. N. Engl J. Med. 1999; 341(15): 1097-105. https://dx.doi.org/10.1056/NEJM199910073411501.
  31. Manson J.E., Willett W.C., Stampfer M.J. et al. Body weight and mortality among women. N. Engl J. Med. 1995; 333(11): 677-85. https://dx.doi.org/10.1056/NEJM199509143331101.

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