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Comparative effects of microvascular and macrovascular disease on the risk of major outcomes in patients with type 2 diabetes.

Identifieur interne : 000F57 ( PubMed/Checkpoint ); précédent : 000F56; suivant : 000F58

Comparative effects of microvascular and macrovascular disease on the risk of major outcomes in patients with type 2 diabetes.

Auteurs : Kamel Mohammedi [Australie] ; Mark Woodward [Australie] ; Michel Marre [France] ; Stephen Colagiuri [Australie] ; Mark Cooper [Australie] ; Stephen Harrap [Australie] ; Giuseppe Mancia [Italie] ; Neil Poulter [Royaume-Uni] ; Bryan Williams [Royaume-Uni] ; Sophia Zoungas [Australie] ; John Chalmers [Australie]

Source :

RBID : pubmed:28750645

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.

DOI: 10.1186/s12933-017-0574-y
PubMed: 28750645


Affiliations:


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pubmed:28750645

Le document en format XML

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<div type="abstract" xml:lang="en">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.</div>
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<DateCreated>
<Year>2017</Year>
<Month>07</Month>
<Day>28</Day>
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<DateRevised>
<Year>2017</Year>
<Month>08</Month>
<Day>03</Day>
</DateRevised>
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<Journal>
<ISSN IssnType="Electronic">1475-2840</ISSN>
<JournalIssue CitedMedium="Internet">
<Volume>16</Volume>
<Issue>1</Issue>
<PubDate>
<Year>2017</Year>
<Month>Jul</Month>
<Day>27</Day>
</PubDate>
</JournalIssue>
<Title>Cardiovascular diabetology</Title>
<ISOAbbreviation>Cardiovasc Diabetol</ISOAbbreviation>
</Journal>
<ArticleTitle>Comparative effects of microvascular and macrovascular disease on the risk of major outcomes in patients with type 2 diabetes.</ArticleTitle>
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<Abstract>
<AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">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.</AbstractText>
<AbstractText Label="METHODS" NlmCategory="METHODS">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.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="RESULTS">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.</AbstractText>
<AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">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.</AbstractText>
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<Affiliation>The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia. kmohammedi@georgeinstitute.org.au.</Affiliation>
</AffiliationInfo>
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<Affiliation>INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France. kmohammedi@georgeinstitute.org.au.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Department of Diabetology, Endocrinology and Nutrition, Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Paris, France. kmohammedi@georgeinstitute.org.au.</Affiliation>
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<Initials>M</Initials>
<AffiliationInfo>
<Affiliation>The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>The George Institute for Global Health, University of Oxford, Oxford, UK.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.</Affiliation>
</AffiliationInfo>
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<LastName>Marre</LastName>
<ForeName>Michel</ForeName>
<Initials>M</Initials>
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<Affiliation>INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Department of Diabetology, Endocrinology and Nutrition, Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Paris, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>University Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Colagiuri</LastName>
<ForeName>Stephen</ForeName>
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<Affiliation>Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.</Affiliation>
</AffiliationInfo>
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<Affiliation>Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.</Affiliation>
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<Affiliation>The University of Melbourne and Royal Melbourne Hospital, Melbourne, VIC, Australia.</Affiliation>
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