Assessment Of Metabolic Factors And Their Interactions In The Risk Of Coronary Heart Disease In Patients With Type 2 Diabetes

Part Ⅰ Prevalence of coronary heart disease and characteristics of cardiovascular risk factors in Chinese patients with type 2 diabetes mellitusObjective: Coronary heart disease(CHD)is the most common cause of death in patients with type 2 diabetes(T2DM).We aim to estimate the prevalence of CHD and cardiovascular risk factors in Chinese patients with T2 DM.Methods: A total of 66536 inpatients with diabetes treated from 2013 to 2018 were investigated,and demographic and clinical data were collected from 30693 patients with T2 DM.Age-standardized prevalence of CHD was calculated on the basis of data from Chinese population census in 2010.Logistic regression analysis was used to analyze the risk factors.Results: The crude prevalence of CHD was estimated to be 23.5% and a standardized prevalence was 13.9%(16.0% in men and 11.9% in women).More than half of patients with CHD have four or more of the 5 traditional risk factors,much higher than38.96% of patients without CHD(p<0.01).Multivariate regression analysis showed that diabetes duration,hypertension,smoking,underweight,overweight,obesity,and hypoglycemia were significantly associated with increased risk of CHD(all p<0.05).The odds ratio of CHD in patients with three,four,or five defined CHD risk factors(i.e.diabetes,hypertension,dyslipidaemia,overweight or obese,and smoking.)were 2.35(95%CI 1.81-3.04),2.96(95%CI 2.28-3.85),or 5.29(95%CI 4.04-6.93),compared with diabetes patients without any other risk factors.Conclusions: The prevalence of CHD was rather high in Chinese T2 DM inpatients,and the aggregation of CHD risk factors was severe.Thus,hierarchical CHD prevention strategies based on risk factors are necessary.Part Ⅱ Assessment of cardiovascular risk factors and their interactions in the risk of coronary heart disease in Chinese patients with type 2 diabetes mellitusObjective: In addition to hyperglycemia and hyperlipidemia,obesity and hypertension are important cardiovascular risk factors for coronary heart disease(CHD)in patients with type 2 diabetes mellitus(T2DM).This study aims to explore the interaction of these risk factors.Methods: Data of hospitalized patients with T2 DM from 2013 to 2018 were collected.A multivariate logistic regression model was established.Patients with normal weight and blood pressure were recruited as controls.The interaction on the risk of CHD was evaluated by relative excess risk due to interaction(RERI).Results: Among the 30693 patients with T2 DM,7202(23.5%)had CHD.In the low weight group,the prevalence of CHD in patients with hypertension was nearly four times higher than that in patients without hypertension(42.7% vs.11.3%,p < 0.01).The OR value of hypertension alone on CHD increased from 1.29(95% CI 1.06–1.56)in the body mass index(BMI)30.0–34.9 kg/m2 group to 1.35(95% CI 1.11–1.62)in the BMI ≤ 18.5 kg/m2 group.Additive interaction was observed between hypertension and BMI in CHD risk,especially in the low weight group(RERI:2.2,95% CI 0.9–3.5).BMI and CHD risk showed a smile curve relationship.The attributive proportion in the low weight group was higher than that in the severe obesity group,that is,0.52(95% CI 0.35–0.69)vs.0.18(95% CI-0.59 to 0.95).Conclusion: Maintaining normal weight and avoiding low weight is particularly important for patients with co-occurring diabetes and hypertension to prevent the risk of CHD.Part Ⅲ Risk factors of acute coronary syndrome and cluster analysis of cardiovascular phenotypes in Chinese patients with type 2 diabetes mellitus and coronary heart diseaseObjective: Patients with Type 2 diabetes mellitus(T2DM)complicated with acute coronary syndrome(ACS)have a poor prognosis.Our objective was to assess the prevalence of ACS and the control and aggregation characteristics of cardiovascular risk factors in Chinese patients with type 2 diabetes mellitus and coronary heart disease,and to identify different cardiovascular phenotypes using cluster analysis.Methods: The medical records of 5875 patients with type 2 diabetes complicated with coronary heart disease who were hospitalized in Zhongda Hospital affiliated to Southeast University from 2013 to 2018 were collected to analyze the prevalence of ACS and the compliance rate and aggregation status of cardiovascular risk factors.The risk factors of ACS were analyzed by Logistic regression analysis.A total of 33 baseline variables(8 categorical variables and 25 continuous variables)were selected for cluster analysis,and the risk of ACS for each cluster was assessed by Logistic regression model.Results: The crude prevalence of ACS was 15.4% in patients with type 2 diabetes mellitus and coronary heart disease,17.9% in men and 12.2% in women.The highest prevalence of ACS was found in the 40-49 years old group.The proportion of triglyceride,low density lipoprotein cholesterol,Hb A1 C not reaching the standard in ACS patients was significantly higher than that in non-ACS patients(all p <0.05),and BMI level was significantly lower than that of nonACS patients(p=0.002).Approximately 90% of patients with type 2 diabetes mellitus and coronary heart disease had 3 or more risk factors aggregation.Compared with diabetic patients without any other cardiovascular risk factors,there was no significant difference in the risk of ACS among patients complicated with 2,3,4 and 5 cardiovascular risk factors(all p > 0.05).There was significant difference in fibrinogen between patients with ACS and without(p<0.05).Two different types of cardiovascular phenotypic cluster were identified by cluster analysis.Patients in cluster Ⅱ with moderate FIB(OR 2.03,95%CI 1.55-2.67,p<0.001)and high level FIB(OR 1.90,95%CI 1.45-2.50,p<0.001)had the highest risk of ACS.Conclusion: The prevalence of ACS is high in patients with type 2 diabetes mellitus and coronary heart disease in China,and the aggregation of cardiovascular risk factors is not the key point for the identification of ACS.Two different clinically distinct groups were identified by cluster analysis,and it is significant to identify ACS patients by fibrinogen stratification.It is necessary to develop hierarchical ACS prevention strategies based on cardiovascular phenotypic analysis combined with fibrinogen stratification.