Relevance of Target-Organ Lesions as Predictors of
					Mortality in Patients with Diabetes Mellitus

Bianco, Henrique Tria; Izar, Maria Cristina; Fonseca, Henrique Andrade; Póvoa, Rui Manuel; Saraiva, José Francisco; Forti, Adriana; Jardim, Paulo Cesar B. V.; Introcaso, Luis; Yugar-Toledo, Juan; Xavier, Hermes Tóros; Faludi, André Arpad; Fonseca, Francisco A. H.

doi:10.5935/abc.20140112

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Original Articles • Arq. Bras. Cardiol. 103 (4) • Oct 2014 • https://doi.org/10.5935/abc.20140112 copy

Relevance of Target-Organ Lesions as Predictors of Mortality in Patients with Diabetes Mellitus

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background:

Patients with diabetes are in extract higher risk for fatal cardiovascular events.

Objective:

To evaluate major predictors of mortality in subjects with type 2 diabetes.

Methods:

A cohort of 323 individuals with type 2 diabetes from several regions of Brazil was followed for a long period. Baseline electrocardiograms, clinical and laboratory data obtained were used to determine hazard ratios (HR) and confidence interval (CI) related to cardiovascular and total mortality.

Results:

After 9.2 years of follow-up (median), 33 subjects died (17 from cardiovascular causes). Cardiovascular mortality was associated with male gender; smoking; prior myocardial infarction; long QTc interval; left ventricular hypertrophy; and eGFR <60 mL/min. These factors, in addition to obesity, were predictors of total mortality. Cardiovascular mortality was adjusted for age and gender, but remained associated with: smoking (HR = 3.8; 95% CI 1.3-11.8; p = 0.019); prior myocardial infarction (HR = 8.5; 95% CI 1.8-39.9; p = 0.007); eGFR < 60 mL/min (HR = 9.5; 95% CI 2.7-33.7; p = 0.001); long QTc interval (HR = 5.1; 95% CI 1.7-15.2; p = 0.004); and left ventricular hypertrophy (HR = 3.5; 95% CI 1.3-9.7; p = 0.002). Total mortality was associated with obesity (HR = 2.3; 95% CI 1.1-5.1; p = 0.030); smoking (HR = 2.5; 95% CI 1.0-6.1; p = 0.046); prior myocardial infarction (HR = 3.1; 95% CI 1.4-6.1; p = 0.005), and long QTc interval (HR = 3.1; 95% CI 1.4-6.1; p = 0.017).

Conclusions:

Biomarkers of simple measurement, particularly those related to target-organ lesions, were predictors of mortality in subjects with type 2 diabetes.

Diabetes Mellitus, Type 2 / mortality; Epidemiology; Diabetes Mellitus, Type 2 / complications

Characteristics and variables	Studied cohort (n = 323)	Initial cohort (n = 434)	p value
Epidemiological data
Age (years)^msd	60(52-66)	60 (53-66)	1.00
Male genderⁿ	132 (41)	179 (41)	1.00
Smokingⁿ	24 (7)	30 (7)	0.89
Medical history
Arterial hypertensionⁿ	276 (85)	354(82)	0.70
DM duration (years)^msd	6(2-11)	6(3-11)	0.99
Family history (CF)ⁿ	90 (28)	110 (25)	0.57
Previous myocardial infarctionⁿ	108 (33)	162 (37)	0.35
BMI (kg/m²)^m	25.6 ± 4.4	29.1 ± 4.9	< 0.001
Overweight/obesityⁿ	172 (53)	347(80)	0.0007
Laboratory data
Glycemia (mg/d)^md	146 (120-192)	154 (123-202)	0.008
Total cholesterol (mg/dL)^m	196 ± 43	198 ± 49	0.56
HDL-C (mg/dL)^m	31 ± 11	36 ± 9.6	< 0.001
LDL-C (mg/dL)^m	124 ± 39	123 ± 38	0.72
Triglycerides (mg/dL)^msd	174 (120-226)	173 (111-248)	0.57
SBP (mmHg)^m	135 ± 21	138 ± 21	0.051
DBP (mmHg)^m	84 ± 11	84 ± 13	1.00
Used medications
Hypoglycemiant agentsⁿ	323 (100)	434 (100)	1.00
Insulin therapyⁿ	59 (18)	80 (18)	1.00
Lipid-lowering therapyⁿ	119 (37)	140 (34)	0.38
Antihypertensive therapyⁿ	261 (81)	343(80)	0.87

Functional stage (impairment)	eGFR mL/min per 1.73 m²	Patients by CKD-EPI (%)
I (normal)	≥ 90 mL/min por 1,73 m²	51.60
II (mild)	60-89 mL/min por 1,73 m²	34.40
III (moderate)	30-59 mL/min por 1,73 m²	12.10
IV (severe)	15-29 mL/min por 1,73 m²	1.30
V (failure)	< 15 mL/min por 1,73 m²	0.60

	Studied population	Initial population
Electrocardiographic variables	(n = 323)	(n = 434)
Sinus rhythm	321 (99)	430 (99)
First degree AV block	7 (2)	8(1.8)
Left bundle branch block	14 (4)	9 (5)
Ventricular ectopia	8 (2.5)	10 (2.3)
Left ventricular hypertrophy	87(28)	126 (29)
Long QT interval ^* * QTc: cutoff value of 450 and 470 ms for men and women, respectively.	54 (17)	69 (15.8)

	Events		Mortality
Variables	Cardiovascular	Coronary	Cardiovascular	Total
Male gender	2.5 (1.6-4.1)	3.1 (1.8-5.4)	4.8 (1.6-14.8)	2.0 (1.0-4.0)
Male gender	p < 0.001	p < 0.001	p = 0.006	p = 0.04
Obesity	1.1 (0.7-1.7)	0.8 (0.5-1.4)	2.9 (0.9-8.9)	2.5 (1.1-5.3)
Obesity	p = 0.66	p = 0.51	p = 0.06	p = 0.021
Smoking	1.6 (0.8-3.3)	1.2 (0.5-2.9)	4.2 (1.4-12.9)	3.2 (1.3-7.7)
Smoking	p = 0.21	p = 0.74	p = 0.012	p = 0.010
Previous infarction	4.9 (3.0-8.0)	6.0 (3.4-10.6)	15.8 (3.6-69.2)	4.3 (2.1-9.0)
Previous infarction	p < 0.001	p < 0.001	p < 0.001	p < 0.001
Age > 65 years	1.3 (0.8-0.3)	1.1 (0.6-1.9)	5.1 (1.9-13.9)	3.4 (1.7-6.8)
Age > 65 years	p = 0.26	p = 0.74	p = 0.001	p < 0.001
eGFR < 60mL/min
Cockroft-Gault	2.2 (1.2-4.2)	3.1 (1.5-6.2)	6.3 (1.8-21.7)	3.8 (1.5-9.7)
Cockroft-Gault	p = 0.02	p = 0.001	p = 0.004	p = 0.005
MDRD	4.5 (2.4-8.6)	4.9 (2.4-9.9)	9.2 (2.6-32.8)	4.7 (1.9-11.6)
MDRD	p < 0.001	p < 0.001	p < 0.001	p < 0.001
CKD-EPI	4.2 (2.2-8.1)	4.5(2.2-9.1)	9.7 (2.7-34.4)	4.9 (2.0-12.2)
CKD-EPI	p < 0.001	p < 0.001	p < 0.001	p = 0.001
Long QTc	2.6 (1.4-5.0)	2.8 (1.4-5.5)	5.2 (1.7-15.6)	3.0 (1.2-7.6)
Long QTc	p = 0.03	p = 0.002	p = 0.003	p = 0.017
LVH	2.0 (1.2-3.1)	1.9(1.1-3.3)	5.0 (1.8-13.5)	2.0 (1.0-4.0)
LVH	p = 0.004	p = 0.001	p = 0.002	p = 0.047
Ventricular ectopia	3.9 (1.6-9.7)	3.4 (1.2-9.4)	2.4 (0.3-18.4)	2.7(0.6-11.0)
Ventricular ectopia	p = 0.003	p = 0.019	p = 0.38	p = 0.17

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