Diabetes type 2: conventional, social and some genetic predictors of cardiovascular death

Abstract

Aim of the study was to investigate the associations of metabolic, behavioral, socio-economic risk factors and some molecular genetic markers with the risk of cardiovascular death (CVD) in persons with type 2 diabetes (T2DM) aged 45–69 years. Material and methods. The analysis included survey data from 681 participants with T2DM. The baseline survey was carried out within the framework of the HAPIEE project. The observation period lasted from 2003– 2005 to December 31, 2018 and averaged 14.7 ± 0.7 years. Persons who at the time of the baseline examination had an indication of a previous myocardial infarction and/or cerebral stroke were excluded from the analysis. The causes of CVD were determined according to the code International Classification of Diseases 10th revision – I (0–99). Within the framework of the study, 2 groups were formed: the main group, which included persons with T2DM who «developed fatal CV events» 2 207 people (107 men and 100 women) and a comparison group – persons with T2DM who «did not develop fatal CV events» for observation period – 474 people (177 men and 297 women). Indicators of anthropometry, blood pressure, socio-demographic data, some biochemical parameters and molecular genetic markers were determined. To analyze the association of the studied factors with the risk of CVD, multivariate stepwise Cox regression analysis was used. Results. The risk factors for CVD common for men and women were determined: age, increased SBP, current smoking, non-working status, fasting blood plasma glucose ≥ 7.5 mmol/L. For men, significant risk factors for CVD were also – heart rate ≥ 75 per minute, lonely status; for women – verified diabetes before the baseline examination. Carriage of the heterozygous AG genotype against the AA + GG rs2464196 HNF1A is associated with a reduced risk of fatal CV events in men, OR = 0.488 (95 % CI 0.254–0.941). Carriage of the heterozygous genotype AC rs11212617 ATM is associated with an increased risk of fatal CV events in both sexes. OR = 1.561 (95 % CI = 1.022–2.384). Conclusion. In men and women with T2DM over a 15-year follow-up, associations were found between the risk of fatal CV events with the level of both «traditional» and «diabetes-related» risk factors, as well as with the HNF1A rs2464196 and ATM rs11212617.

Keywords

• type 2 diabetes mellitus
• fasting blood plasma glucose
• cardiovascular death
• arterial hypertension
• tobacco smoking
• marital status
• heart rate