A 1-SD increase in the diastolic rate constant was independently associated with a higher risk of MACE in older adults with type 2 diabetes (HR 1.268; 95% CI 1.003-1.603; p=0.047).
Cohort (n=387)
Yes
Does reservoir-excess pressure analysis predict long-term major adverse cardiovascular events in older adults with type 2 diabetes?
Diastolic rate constant derived from reservoir-excess pressure analysis is an independent predictor of long-term major adverse cardiovascular events in older adults with type 2 diabetes, suggesting utility for cardiovascular risk stratification.
Hazard Ratio: 1.268 (95% CI 1.003–1.603)
p-value: p=0.047
Objective: Arterial haemodynamics play a crucial role in the development of cardiovascular disease. Reservoir-excess pressure analysis has demonstrated an association with short-term (i.e., three years) major adverse cardiovascular events (MACE) in people with type 2 diabetes. However, evidence is still absent whether reservoir-excess pressure parameters would predict MACE over a longer follow-up period. We determined whether reservoir-excess pressure parameters were associated with long-term occurrence of MACE in people with type 2 diabetes. Design and method: We studied 387 older adults with type 2 diabetes (71±8 yrs, 113 females) who participated in the SUMMIT-VIP study. Radial artery tonometry was performed using a SphygmoCor system at baseline, and reservoir-excess pressure parameters were calculated from an ensemble-averaged radial pressure waveform including reservoir pressure integral, peak reservoir pressure (MAXPR), excess pressure integral (INTXSP), systolic rate constant and diastolic rate constant (DRC). Associations between reservoir-excess pressure parameters and MACE (a composite of coronary heart disease, stroke, coronary artery bypass graft, percutaneous coronary intervention, heart failure and cardiovascular mortality occurred during follow-up) were determined using multivariable Cox proportional hazard regression analyses. Data were expressed as hazard ratio with 95% confidence intervals. Results: During a median follow-up period of 8.2 yrs, 97 first-time MACE occurred. One standard deviation (SD) increase in MAXPR, INTXSP and DRC was associated with MACE after adjusting for age, sex and study centre MAXPR, 1.429 (1.152, 1.773), p<0.001; INTXSP, 1.297 (1.070, 1.572), p=0.008; DRC, 1.350 (1.076, 1.695), p=0.010. The association with MACE was only retained for DRC 1.268 (1.003, 1.603), p=0.047 after accounting for conventional cardiovascular risk factors and potential confounders. A similar result was observed after further accounting for non-cardiovascular or unknown cause of deaths as a competing risk 1.289 (1.013, 1.641), p=0.039. Other reservoir-excess pressure parameters did not demonstrate an association with MACE. Conclusions: DRC was associated with MACE in older people with type 2 diabetes. The finding demonstrates a clinical utility of reservoir-excess pressure analysis for cardiovascular risk stratification in people with type 2 diabetes.
Aizawa et al. (Fri,) conducted a cohort in Type 2 diabetes (n=387). Reservoir-excess pressure parameters (diastolic rate constant) was evaluated on MACE (composite of coronary heart disease, stroke, coronary artery bypass graft, percutaneous coronary intervention, heart failure and cardiovascular mortality) (HR 1.268, 95% CI 1.003-1.603, p=0.047). A 1-SD increase in the diastolic rate constant was independently associated with a higher risk of MACE in older adults with type 2 diabetes (HR 1.268; 95% CI 1.003-1.603; p=0.047).