Type 2 diabetes (T2D) may play a protective role against the development of aortic diseases through structural changes in the aortic wall, according to an observational cohort study published in the Journal of the American Heart Association.1
Although T2D is associated with cardiovascular disease and excess mortality, no studies have evaluated the long-term risks for aortic aneurysm (AA) and aortic dissection or mortality after hospitalization for these events in patients with T2D.1-3
Therefore, researchers linked data from 448,319 patients with T2D in the Swedish National Diabetes Register and 2,251,015 population-based control subjects (CSs) without T2D to other national databases to capture hospitalizations and death from 1998 to 2015.1
They found that patients with T2D had a 28% relative risk reduction of hospitalization for AA and a 47% relative risk reduction of hospitalization for aortic dissection compared with CSs. In addition, adjusted mortality rates after hospitalization for AA were 12% lower among patients with T2D compared with CSs.
Although the mechanisms of the protective effects of T2D on aortic disease are unknown, data suggest that T2D alters the aortic tissue through glycemic cross-links that stabilize the aorta and prevent aortic dilatation, aneurysm growth, and rupture.1,4-7
Strengths of this study included one of the largest study populations to date with nationwide valid data on T2D, comorbidities, and outcomes, and a long mean follow-up period of approximately 7 years. Limitations include residual confounders because of the observational design of the study.
"In conclusion, this nationwide, observational, longitudinal cohort study found that patients with T2DM have a significantly reduced risk of hospitalization for AA and [aortic dissection] compared with CSs, as well as significantly reduced short-term risk of mortality after hospitalization for AA," the authors stated.1
References
Avdic T, Franzén S, Zarrouk M, et al. Reduced long-term risk of aortic aneurysm and aortic dissection among individuals with type 2 diabetes mellitus: a nationwide observational study. J Am Heart Assoc.
2018;7:e007618.
Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993;16:434-444.
Gæde P, Vedel P, Larsen N, Jensen GVH, Parving H-H, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;348:383-393.
Lederle FA, Johnson GR, Wilson SE, et al. Prevalence and associations of abdominal aortic aneurysm detected through screening. Ann Intern Med. 1997;126:441-449.
Golledge J, Karan M, Moran CS, et al. Reduced expansion rate of abdominal aortic aneurysms in patients with diabetes may be related to aberrant monocyte-matrix interactions. Eur Heart J. 2008;29:665-672
.Dua MM, Miyama N, Azuma J, et al. Hyperglycemia modulates plasminogen activator inhibitor-1 expression and aortic diameter in experimental aortic aneurysm disease. Surgery. 2010;148:429-435.
Chen XF, Wang JA, Lin XF, et al. Diabetes mellitus: is it protective against aortic root dilatation? Cardiology. 2009;112:138-143.
Abstract
Background No studies have examined long‐term risks for aortic aneurysm (AA) and aortic dissection (AD) or mortality after AA or AD hospitalization among patients with type 2 diabetes mellitus (T2DM).
Methods and Results In this observational cohort study, we linked data for patients with T2DM in the Swedish National Diabetes Register, and 5 individually matched population‐based control subjects (CSs) without diabetes mellitus (on the basis of sex, age, and county), to other national databases to capture hospitalizations and death.
We examined the risk of hospitalization for AA and AD, as well as mortality risk after AA and AD using Kaplan‐Meier curves and Cox regression hazards models. Data on 448 319 patients with T2DM and 2 251 015 CSs were obtained between 1998 and 2015. Mean follow‐up time was 7.0 years for the T2DM group and 7.2 years for the CS group. Patients with T2DM had a relative risk reduction of 28% (hazard ratio, 0.72; 95% confidence interval, 0.68–0.76; P<0.0001) for AAand a 47% relative risk reduction (hazard ratio, 0.53; 95% confidence interval, 0.42–0.65; P<0.0001) for AD compared with CSs. Patients with T2DM had a relative risk reduction of 12% (hazard ratio, 0.88; 95% confidence interval, 0.82–0.94; P<0.0001) for mortality after hospitalization for AA, and unaltered risk (hazard ratio, 1.07; 95% confidence interval, 0.85–1.34; P=0.5859) for mortality after AD, up to 2 years compared with CSs.
Conclusions Patients with T2DM had significantly reduced risks of AA and AD as well as reduced risk of mortality after hospitalization for AA, compared to CS. Data suggest that glycated cross‐links in aortic tissue may play a protective role in the progression of aortic diseases among patients with T2DM.
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