In Chinese Patients, Arterial Stiffness May Be Better Predictor of Diabetes than Blood Pressure

This article was originally published on PracticalCardiology.com.

Although blood pressure is often looked to as a predictor of adverse outcomes, including development of diabetes mellitus, new research suggests measurements of arterial stiffness may be a better predictor of diabetes risk among patients of Chinese ancestry.

An analysis of data from an ongoing, prospective study in China, results of the current study indicate arterial stiffness provided better predictive ability for diabetes than hypertension in multiple sensitivity and subgroup analyses as well as providing a greater incremental effect on the predictive value when added to a conventional risk prediction models with traditional risk factors.

“We were surprised to find that people with increased arterial stiffness were more likely to develop Type 2 diabetes, whether they had high blood pressure or not,” said senior investigator Anxin Wang, PhD, a researcher at the China National Clinical Research Center for Neurological Diseases at Beijing Tiantan Hospital in a statement from the American Heart Association (AHA). “These results provide strong evidence that measuring arterial stiffness may be a better predictor than blood pressure in determining an individual’s future risk of type 2 diabetes.”

With type 2 diabetes posing a significant threat to patient- and population-level health, prevention efforts have taken center stage for providers in endocrinology, cardiology, and internal medicine. Citing previous research suggesting arterial stiffness may be a better predictor of adverse clinical events than blood pressure and a lack of research comparing predictive ability for type 2 diabetes, Wang and a team of colleagues from the Beijing Tiantan Hospital launched the current study to assess the status of hypertension and arterial stiffness, which was measured as brachial-ankle pulse wave velocity (baPWV), in predicting future risk of type 2 diabetes in a community-based population in China.

With this in mind, investigators designed their study as an analysis of the ongoing, prospective Kailuan study. Starting in 2006, the Kailuan study has enrolled more than 100,000 patients and conducted examination surveys every 2 years. Beginning with survey cycle 3 in 2010, patients who consented to join nested studies on vascular health underwent assessments of baPWV. For the current study, investigators included those with at least 1 completed survey from 2010-2014 with synchronized data and no history of diabetes or prediabetes, yielding a cohort of 11,156 patients for inclusion in their analyses.

This cohort had a mean age of 51.53±11.62 years, 57.19% were men, the mean BMI was 24.8±3.40 kg/m2, and the mean baPWV was 1492.83±350.64 cm/s. During a follow-up period lasting a median of 6.16 (IQR, 5.02-7.00) years, a total of 768 incident cases of diabetes were identified by investigators.

Compared to those with ideal vascular function, the greatest risk of diabetes during the follow-up period was observed among those with hypertension and elevated arterial stiffness (HR, 2.42 [95% CI, 1.93-3.03]; P <.0001), followed by normotensive patients with elevated arterial stiffness (HR, 2.11 [95% CI, 1.68-2.66]; P <.0001), and those with hypertension and normal arterial stiffness (HR, 1.48 [95% CI, 1.08-2.02]; P <.0001). Further subgroup and sensitivity analyses yielded similar results.

Additionally, in analyses comparing the predictive value of hypertension and arterial stiffness, C statistics in a conventional model significantly improved with the addition of arterial stiffness, from 0.690 to 0.707 (P=.0003), but did not significantly improve with the addition of hypertension (P=.0807). Investigators also pointed out the discriminatory power and risk classification of arterial stiffness appeared to be greater than hypertension, with the integrated discrimination improvement for hypertension at 0.28% (95% CI, 0.02-0.40%; P <.0001) and 0.65% (95% CI, 0.47-0.84%; P <.0001), while the corresponding net reclassification index was 34.59% (95% CI, 27.31-41.87%; P <0.0001) and 40.48% (95% CI, 33.46-47.50%; P <.0001) for arterial stiffness.

“This finding that arterial stiffness increases the risk for developing Type 2 diabetes supports our existing understanding of cardiovascular disease and Type 2 diabetes,” said Eduardo Sanchez, MD, MPH, chief medical officer for prevention of the AHA and clinical lead for Know Diabetes by Heart, in the aforementioned statement. “We look forward to future investigations about the mechanisms between arterial stiffness and type 2 diabetes risk.”

This study, “Hypertension, Arterial Stiffness, and Diabetes: a Prospective Cohort Study,” was published in Hypertension.