Comparative effects of microvascular and macrovascular disease on the risk of major outcomes in patients with type 2 diabetes
Identifieur interne : 000F48 ( Main/Exploration ); précédent : 000F47; suivant : 000F49Comparative effects of microvascular and macrovascular disease on the risk of major outcomes in patients with type 2 diabetes
Auteurs : Kamel Mohammedi [Australie, France] ; Mark Woodward [Australie, Royaume-Uni, États-Unis] ; Michel Marre [France] ; Stephen Colagiuri [Australie] ; Mark Cooper ; Stephen Harrap ; Giuseppe Mancia [Italie] ; Neil Poulter [Royaume-Uni] ; Bryan Williams [Royaume-Uni] ; Sophia Zoungas [Australie] ; John Chalmers [Australie]Source :
- Cardiovascular Diabetology [ 1475-2840 ] ; 2017.
Abstract
Microvascular disease is associated with a high risk of macrovascular events in patients with type 2 diabetes, but the impact of macrovascular disease on the risk of microvascular events remains unknown. We sought to evaluate the respective effects of prior microvascular and macrovascular disease on the risk of major outcomes, including microvascular events, in these patients.
Participants in the Action in Diabetes and Vascular Disease: PreterAx and DiamicroN Modified-Release Controlled Evaluation (ADVANCE) trial (n = 11,140) and the ADVANCE-ON post-trial study (n = 8494) were categorized into 4 groups at baseline: dual absence of microvascular or macrovascular disease (n = 6789), presence of microvascular disease alone (n = 761), macrovascular disease alone (n = 3196), and both (n = 394). Outcomes were all-cause mortality, major macrovascular events (MACE), and major clinical microvascular events.
All-cause mortality, MACE, and major clinical microvascular events occurred in 2265 (20%), 2166 (19%), and 807 (7%) participants respectively, during a median follow-up of 9.9 (inter-quartile interval 5.6–10.9) years. The adjusted hazard ratios [95% CI] of death, MACE, and major clinical microvascular events were each greater in patients with baseline microvascular disease (1.43 [1.20–1.71], 1.64 [1.37–1.97], and 4.74 [3.86–5.82], respectively), macrovascular disease (1.43 [1.30–1.57], 2.04 [1.86–2.25], and 1.26 [1.06–1.51]) or both (2.01 [1.65–2.45], 2.92 [2.40–3.55], and 6.30 [4.93–8.06]) compared with those without these conditions. No interaction was observed between baseline microvascular and macrovascular disease for these events. The addition of microvascular disease (change in c-statistic [95% CI] 0.005 [0.002–0.008], p = 0.02) or macrovascular disease (0.005 [0.002–0.007], p < 0.0001) considered separately or together (0.011 [0.007–0.014], p < 0.0001) improved the discrimination and the classification (integrated discrimination improvement (IDI): 0.013 [0.010–0.016], p < 0.001; net reclassification improvement (NRI): 0.021 [0.011–0.032], p < 0.001) of the risk of all-cause mortality. Microvascular disease improved discrimination (0.009 [0.003–0.014]) and classification (IDI: 0.008 [0.006–0.010]; NRI: 0.011 [0.001–0.020]) of MACE. Baseline macrovascular disease modestly enhanced IDI (0.002 [0.001–0.002]) and NRI (0.041 [0.002–0.087]), but not discrimination, of major clinical microvascular events.
Microvascular and macrovascular disease are independently associated with the 10-year risk of death, MACE, and major clinical microvascular events in patients with type 2 diabetes. The coexistence of these conditions was associated with the highest risks.
The online version of this article (doi:10.1186/s12933-017-0574-y) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/s12933-017-0574-y
PubMed: 28750645
PubMed Central: 5530952
Affiliations:
- Australie, France, Italie, Royaume-Uni, États-Unis
- Maryland, Nouvelle-Galles du Sud, Île-de-France
- Paris
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xml:lang="fr">Royaume-Uni</country><wicri:regionArea>London</wicri:regionArea></affiliation></author><author><name sortKey="Williams, Bryan" sort="Williams, Bryan" uniqKey="Williams B" first="Bryan" last="Williams">Bryan Williams</name><affiliation wicri:level="1"><nlm:aff id="Aff12"><institution-wrap><institution-id institution-id-type="ISNI">0000000121901201</institution-id><institution-id institution-id-type="GRID">grid.83440.3b</institution-id><institution>Institute of Cardiovascular Sciences,</institution><institution>University College London (UCL) and NIHR UCL Hospitals Biomedical Research Centre,</institution></institution-wrap>London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>London</wicri:regionArea></affiliation></author><author><name sortKey="Zoungas, Sophia" sort="Zoungas, Sophia" uniqKey="Zoungas S" first="Sophia" last="Zoungas">Sophia Zoungas</name><affiliation wicri:level="2"><nlm:aff id="Aff1">The George Institute for Global Health, University of Sydney, Sydney, NSW Australia</nlm:aff><country>Australie</country><placeName><region type="state">Nouvelle-Galles du Sud</region></placeName><wicri:cityArea>The George Institute for Global Health, University of Sydney, Sydney</wicri:cityArea></affiliation><affiliation><nlm:aff id="Aff13"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 7857</institution-id><institution-id institution-id-type="GRID">grid.1002.3</institution-id><institution>Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine,</institution><institution>Monash University,</institution></institution-wrap>Clayton, VIC Australia</nlm:aff><wicri:noCountry code="subfield">VIC Australia</wicri:noCountry></affiliation></author><author><name sortKey="Chalmers, John" sort="Chalmers, John" uniqKey="Chalmers J" first="John" last="Chalmers">John Chalmers</name><affiliation wicri:level="2"><nlm:aff id="Aff1">The George Institute for Global Health, University of Sydney, Sydney, NSW Australia</nlm:aff><country>Australie</country><placeName><region type="state">Nouvelle-Galles du Sud</region></placeName><wicri:cityArea>The George Institute for Global Health, University of Sydney, Sydney</wicri:cityArea></affiliation></author></analytic><series><title level="j">Cardiovascular Diabetology</title><idno type="eISSN">1475-2840</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p id="Par1">Microvascular disease is associated with a high risk of macrovascular events in patients with type 2 diabetes, but the impact of macrovascular disease on the risk of microvascular events remains unknown. We sought to evaluate the respective effects of prior microvascular and macrovascular disease on the risk of major outcomes, including microvascular events, in these patients.</p></sec><sec><title>Methods</title><p id="Par2">Participants in the Action in Diabetes and Vascular Disease: PreterAx and DiamicroN Modified-Release Controlled Evaluation (ADVANCE) trial (n = 11,140) and the ADVANCE-ON post-trial study (n = 8494) were categorized into 4 groups at baseline: dual absence of microvascular or macrovascular disease (n = 6789), presence of microvascular disease alone (n = 761), macrovascular disease alone (n = 3196), and both (n = 394). Outcomes were all-cause mortality, major macrovascular events (MACE), and major clinical microvascular events.</p></sec><sec><title>Results</title><p id="Par3">All-cause mortality, MACE, and major clinical microvascular events occurred in 2265 (20%), 2166 (19%), and 807 (7%) participants respectively, during a median follow-up of 9.9 (inter-quartile interval 5.6–10.9) years. The adjusted hazard ratios [95% CI] of death, MACE, and major clinical microvascular events were each greater in patients with baseline microvascular disease (1.43 [1.20–1.71], 1.64 [1.37–1.97], and 4.74 [3.86–5.82], respectively), macrovascular disease (1.43 [1.30–1.57], 2.04 [1.86–2.25], and 1.26 [1.06–1.51]) or both (2.01 [1.65–2.45], 2.92 [2.40–3.55], and 6.30 [4.93–8.06]) compared with those without these conditions. No interaction was observed between baseline microvascular and macrovascular disease for these events. The addition of microvascular disease (change in c-statistic [95% CI] 0.005 [0.002–0.008], p = 0.02) or macrovascular disease (0.005 [0.002–0.007], p < 0.0001) considered separately or together (0.011 [0.007–0.014], p < 0.0001) improved the discrimination and the classification (integrated discrimination improvement (IDI): 0.013 [0.010–0.016], p < 0.001; net reclassification improvement (NRI): 0.021 [0.011–0.032], p < 0.001) of the risk of all-cause mortality. Microvascular disease improved discrimination (0.009 [0.003–0.014]) and classification (IDI: 0.008 [0.006–0.010]; NRI: 0.011 [0.001–0.020]) of MACE. Baseline macrovascular disease modestly enhanced IDI (0.002 [0.001–0.002]) and NRI (0.041 [0.002–0.087]), but not discrimination, of major clinical microvascular events.</p></sec><sec><title>Conclusions</title><p id="Par4">Microvascular and macrovascular disease are independently associated with the 10-year risk of death, MACE, and major clinical microvascular events in patients with type 2 diabetes. The coexistence of these conditions was associated with the highest risks.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1186/s12933-017-0574-y) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Cordero, A" uniqKey="Cordero A">A Cordero</name></author><author><name sortKey="Lopez Palop, R" uniqKey="Lopez Palop R">R Lopez-Palop</name></author><author><name sortKey="Carrillo, P" uniqKey="Carrillo P">P Carrillo</name></author><author><name sortKey="Moreno Arribas, J" uniqKey="Moreno Arribas J">J Moreno-Arribas</name></author><author><name sortKey="Bertomeu Gonzalez, V" uniqKey="Bertomeu Gonzalez V">V Bertomeu-Gonzalez</name></author><author><name sortKey="Frutos, A" uniqKey="Frutos A">A Frutos</name></author><author><name sortKey="Garcia Carrilero, M" uniqKey="Garcia Carrilero M">M 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sortKey="Van Alphen, Fp" uniqKey="Van Alphen F">FP van Alphen</name></author><author><name sortKey="Graiani, G" uniqKey="Graiani G">G Graiani</name></author><author><name sortKey="Spinetti, G" uniqKey="Spinetti G">G Spinetti</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Australie</li><li>France</li><li>Italie</li><li>Royaume-Uni</li><li>États-Unis</li></country><region><li>Maryland</li><li>Nouvelle-Galles du Sud</li><li>Île-de-France</li></region><settlement><li>Paris</li></settlement></list><tree><noCountry><name sortKey="Cooper, Mark" sort="Cooper, Mark" uniqKey="Cooper M" first="Mark" last="Cooper">Mark Cooper</name><name sortKey="Harrap, Stephen" sort="Harrap, Stephen" uniqKey="Harrap S" first="Stephen" last="Harrap">Stephen Harrap</name></noCountry><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Mohammedi, Kamel" sort="Mohammedi, Kamel" uniqKey="Mohammedi K" first="Kamel" last="Mohammedi">Kamel Mohammedi</name></region><name sortKey="Chalmers, John" sort="Chalmers, John" uniqKey="Chalmers J" first="John" last="Chalmers">John Chalmers</name><name sortKey="Colagiuri, Stephen" sort="Colagiuri, Stephen" uniqKey="Colagiuri S" first="Stephen" last="Colagiuri">Stephen Colagiuri</name><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name><name sortKey="Zoungas, Sophia" sort="Zoungas, Sophia" uniqKey="Zoungas S" first="Sophia" last="Zoungas">Sophia Zoungas</name></country><country name="France"><region name="Île-de-France"><name sortKey="Mohammedi, Kamel" sort="Mohammedi, Kamel" uniqKey="Mohammedi K" first="Kamel" last="Mohammedi">Kamel Mohammedi</name></region><name sortKey="Marre, Michel" sort="Marre, Michel" uniqKey="Marre M" first="Michel" last="Marre">Michel Marre</name><name sortKey="Marre, Michel" sort="Marre, Michel" uniqKey="Marre M" first="Michel" last="Marre">Michel Marre</name><name sortKey="Marre, Michel" sort="Marre, Michel" uniqKey="Marre M" first="Michel" last="Marre">Michel Marre</name><name sortKey="Mohammedi, Kamel" sort="Mohammedi, Kamel" uniqKey="Mohammedi K" first="Kamel" last="Mohammedi">Kamel Mohammedi</name></country><country name="Royaume-Uni"><noRegion><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name></noRegion><name sortKey="Poulter, Neil" sort="Poulter, Neil" uniqKey="Poulter N" first="Neil" last="Poulter">Neil Poulter</name><name sortKey="Williams, Bryan" sort="Williams, Bryan" uniqKey="Williams B" first="Bryan" last="Williams">Bryan Williams</name></country><country name="États-Unis"><region name="Maryland"><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name></region></country><country name="Italie"><noRegion><name sortKey="Mancia, Giuseppe" sort="Mancia, Giuseppe" uniqKey="Mancia G" first="Giuseppe" last="Mancia">Giuseppe Mancia</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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