Feasibility Study of Advanced Cardiovascular Screening in Middle-Aged Patients with Diabetes

Figures & data

Table 1 Baseline Characteristics

	Overall	Women	Men
Number of participants	167	70	97
Age, years	52 (±5)	52 (±6)	53 (±8)
Type 2 diabetes	137 (82%)	61 (87%)	76 (78%)
Duration of diabetes	9 (4–15)	9 (4–14)	9 (4–15)
Quality of life	75 (60–80)	70 (50–80)	75 (60–85)
Body Mass Index, kg/m^2	33 (±6)	34 (±7)	32 (±6)
Family history of CVD	39 (23%)	25 (36%)	14 (14%)
Smoking Status
Non-smokers	68 (41%)	26 (37%)	42 (43%)
Former smokers	56 (34%)	22 (31%)	34 (35%)
Active smokers	43 (26%)	22 (31%)	21 (22%)
Blood Pressure
Systolic, mmHg	145 (±17)	144 (±20)	146 (±15)
Diastolic, mmHg	83 (±9)	83 (±9)	83 (±8)
High blood pressure	151 (90%)	61 (87%)	90 (93%)
HbA1c, mmol/mol	55 (±14)	55 (±13)	56 (±15)
HbA1c > individual goal	90 (54%)	38 (55%)	52 (54%)
HDL, mmol/L	1.3 (±0.4)	1.4 (±0.4)	1.2 (±0.4)
LDL, mmol/L	2.2 (±0.8)	2.2 (±0.9)	2.3 (±0.8)
≥2.6 mmol/L	51 (32%)	17 (26%)	34 (37%)
Total cholesterol, mmol/L	4.4 (±1.0)	4.5 (±1.1)	4.4 (±0.9)
eGFR, mL/min	94 (±16)	94 (±17)	93 (±16)
<60 mL/min	9 (5%)	3 (4%)	6 (6%)
Microalbuminuria, mg/L	6 (0–17)	7 (0–15)	5 (0–19)
≥30 mg/L	33 (20%)	12 (17%)	21 (22%)
Preventive Treatment
Statin	102 (61%)	46 (66%)	56 (58%)
Antihypertensive	102 (61%)	41 (59%)	61 (63%)
Antithrombotic	17 (10%)	5 (7%)	12 (12%)
Antidiabetic Treatment
Non-medical	8 (5%)	6 (9%)	2 (2%)
Metformin	120 (72%)	51 (73%)	69 (71%)
Insulin	52 (31%)	20 (29%)	32 (33%)
SLGT-2i	19 (11%)	9 (13%)	10 (10%)
GPL-1a	21 (13%)	13 (19%)	8 (8%)
DPP-4i	21 (13%)	10 (14%)	11 (11%)

Notes: Numbers are n (%), mean (±SD), median (quartile 1 – quartile 3). p-value for difference between women and men.

Abbreviations: CVD, cardiovascular disease; DPP-4i, dipeptidyl peptidase 4 inhibitors; HbA1_c, haemoglobin A1c; HDL, high-density lipoprotein; GPL-1a, glucagon-like peptide-1 receptor agonists; LDL, low-density lipoprotein; eGFR, estimated glomerular filtration rate; SD, standard deviation; SGLT-2i, sodium-glucose cotransporter-2 inhibitors.

Table 2 Subclinical Cardiovascular Disease Among Females and Males

	Overall	Females	Males
No of participants	167	70	97
Any subclinical cardiovascular finding	107 (64%)	34 (49%)	73 (75%)
1. CAC score above expected	95 (57%)	27 (39%)	68 (70%)
0, AU	68 (41%)	42 (61%)	26 (27%)
1–99, AU	51 (31%)	15 (22%)	36 (37%)
100–399, AU	24 (14%)	7 (10%)	17 (18%)
≥400, AU	23 (14%)	5 (7%)	18 (19%)
2. Aortic aneurysms	2 (1%)	0	2 (2%)
3. nAtrial fibrillation	6 (4%)	3 (4%)	3 (3%)
4. Peripheral artery disease	11 (7%)	2 (3%)	9 (9%)
5. pro-BNP ≥125 pg/mL	12 (7%)	7 (10%)	5 (5%)
6. Aortic valve calcification score ≥300AU	5 (3)	2 (3%)	3 (3%)
7. Significantly enlarged left atrial volume	6 (4%)	3 (4%)	3 (3%)

Notes: Numbers are n (%). p-value for difference between women and men.

Abbreviations: CAC, coronary artery calcification; AU, arbitrary unit; pro-BNP, NT-Pro B-type natriuretic peptide.

Table 3 Subclinical Cardiovascular Disease According to the Number of Risk Factors Outside Target Range

	Number of Risk Factors* Outside Target Range
	0 or 1	2	3	4
No of participants	37	62	49	19
Any subclinical cardiovascular finding	25 (68%)	39 (63%)	32 (65%)	11 (61%)
1. CAC score above expected	21 (57%)	36 (58%)	31 (63%)	7 (39%)
0, AU	15 (41%)	25 (40%)	18 (37%)	10 (56%)
1–99, AU	13 (35%)	21 (34%)	12 (24%)	5 (28%)
100–399, AU	5 (14%)	8 (13%)	9 (19%)	2 (11%)
≥400, AU	4 (11%)	8 (13%)	10 (20%)	1 (6%)
2. Aortic aneurisms	0	2 (3%)	0	0
3. Atrial fibrillation	1 (3%)	1 (2%)	2 (4%)	2 (11%)
4. Peripheral artery disease	1 (3%)	4 (6%)	2 (4%)	4 (21%)
5. pro-BNP ≥125 pg/mL	4 (11%)	5 (8%)	1 (2%)	2 (11%)
6. Aortic valve calcification score ≥300 AU	2 (5%)	3 (5%)	0	0
7. Significant enlarged left atrial volume	0	3 (5%)	3 (6%)	0

Notes: Numbers are n (%). p-value for difference between females and males. *Current smoker, systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mmHg, HbA1_c ≥ individual HbA1_c target, LDL ≥ 2.6 mmol/l, and microalbuminuria.

Abbreviations: CAC, coronary artery calcification; AU, arbitrary unit; pro-BNP, NT-Pro B-type natriuretic peptide.

Table 4 Univariate and Multivariate Logistic Regression. Associations Between Presence of Subclinical Cardiovascular Disease and Various Cardiovascular Risk Factors

	Univariate Analysis		Multivariate Analysis
	OR	95% CI	OR	95% CI
Number of risk factors* outside target range	0.90	0.65–1.23	0.90	0.63–1.29
Age, years	1.11	1.04–1.19
Male sex	3.22	1.67–6.22	4.41	2.06–9.46
Diabetes duration, years	1.03	0.995–1.06	1.11	1.04–1.18
Type 2 diabetes vs type 1 diabetes	1.23	0.55–2.78	14.9	2.91–76.48
Body mass index, kg/m^2	0.99	0.94–1.04	1.01	0.95–1.07
Family history of CVD	0.87	0.41–1.82	1.51	0.64–3.58
eGFR, mL/min	0.98	0.96–1.002	0.98	0.96–1.01

Notes: *Current smoker, systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mmHg, HbA1_c ≥ individual HbA1_c target, LDL≥2.6 mmol/l, and microalbuminuria.

Abbreviations: CVD, cardiovascular disease; eGFR, estimated glomerular filtration rate.

Table 5 Baseline Treatment and Subclinical Cardiovascular Disease

	Subclinical Cardiovascular Disease
	No	Yes
No of participants	60	107
Preventive Treatment
Statin	34 (57%)	68 (64%)
Antihypertensive	31 (52%)	71 (66%)
Antithrombotic	4 (7%)	13 (12%)
Antidiabetic Treatment
Non-medical	2 (3%)	6 (6%)
Metformin	40 (67%)	80 (75%)
Insulin	19 (32%)	33 (31%)
SLGT-2i	7 (12%)	12 (11%)
GPL-1a	9 (15%)	12 (11%)
DPP-4i	6 (10%)	15 (14%)

Note: Numbers are n (%).

Abbreviations: DPP-4i, dipeptidyl peptidase 4 inhibitors; GPL-1a, glucagon-like peptide-1 receptor agonists; SGLT-2i, sodium-glucose cotransporter-2 inhibitors.