Diabetes mellitus type 2: the relationship of baseline clinical, laboratory and echocardiographic parameters with long-term major adverse cardiovascular events

Background: Type 2 diabetes mellitus (T2DM) increases the risk of developing cardiovascular disease. The search for factors interrelated with the development of major adverse cardiovascular events (MACE) in patients with T2DM over a long period of observation is urgent.

Aim: To reveal the relationship of clinical, laboratory and echocardiographic parameters with the development of long-term MACE in T2DM.

Materials and methods: 94 patients with T2DM (mean age — 55,3 ± 5,5 years, 65% of women) without manifestations of moderate and severe chronic heart failure (CHF), impaired renal function, severe somatic pathology underwent a ­complete clinical and laboratory examination. Echocardiography and 6-minute walk test (6mwt) were performed. The plasma level of the N-terminal propeptide of natriuretic hormone B-type (NT-proBNP) was determined. The variability of fasting blood glucose and intraday glycemic variability were measured by calculating the standard deviation (SD) and the coefficient of variation (CV) of at least 3 blood glucose values for 3 days. Analysis of MACE (death from any cause, myocardial infarction, stroke, decompensation of CHF, myocardial revascularization for emergency indications) was performed after 8,8 ± 0,72 years (n=88). Patients with T2DM were divided into 2 groups — without MACE (group 1, n=54) and with MACE (group 2, n=34). The search for predictors of long-term MACE in T2DM was carried out using the method of logistic regression.

Results: Initially, group 2 differed from group 1 in a longer duration of T2DM, a higher incidence of stable coronary heart disease (55,9% vs 27,8%, p = 0,008), a higher presence of albuminuria>30 mg/day (66,7% vs 37,3% , p=0,008), a higher presence of initial symptoms of CHF (67,8% vs 21,8%, p=0,001), greater fasting glucose variability (SD 2,07 mmol/l vs 1,2 mmol/l, p=0,003), greater intraday glucose variability (SD 2,3 mmol/l vs 1,6 mmol/l, p=0,001, CV 28,2% vs 18,8%, p=0,001), higher levels of NT-proBNP (46,9 pg/ml vs 24,2 pg/ml, p=0,012), larger left atrial size (4,4 cm vs 4,1 cm, p=0,039), shorter 6mwt distance. The logistic regression method revealed the parameters that are most interconnected with long-term MACE in T2DM: intraday glycemic CV (p=0,0012), left atrial size (p=0,02) and initial manifestations of CHF (p=0,03).

Conclusion: The development of long-term MACE in T2DM is associated with an increase in glycemic variability, an increase in NT-proBNP level, an increase in the left atrial size, and a decrease in exercise tolerance. According to logistic regression data, the most significant indicators associated with adverse outcomes are an increase in intraday glycemic CV, an increase in the left atrial size, and the presence of initial symptoms of CHF.

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