Positive association between baseline brachial-ankle pulse wave velocity and the risk of new-onset diabetes in hypertensive patients

Yuanyuan Zhang, Panpan He, Youbao Li, Yan Zhang, Jianping Li, Min Liang, Guobao Wang, Genfu Tang, Yun Song, Binyan Wang, Chengzhang Liu, Lishun Liu, Yimin Cui, Xiaobin Wang, Yong Huo, Xiping Xu, Xianhui Qin, Yuanyuan Zhang, Panpan He, Youbao Li, Yan Zhang, Jianping Li, Min Liang, Guobao Wang, Genfu Tang, Yun Song, Binyan Wang, Chengzhang Liu, Lishun Liu, Yimin Cui, Xiaobin Wang, Yong Huo, Xiping Xu, Xianhui Qin

Abstract

Background: There is no clearly defined temporal relationship between arterial stiffness and diabetes. We aimed to investigate the prospective association between baseline brachial-ankle pulse wave velocity (baPWV) and the risk of new-onset diabetes during follow-up, and examined whether there were effect modifiers, in hypertensive patients.

Methods: We included 2429 hypertensive patients with all the pertinent data but without diabetes at the baseline, who were part of the China Stroke Primary Prevention Trial (CSPPT), a randomized, double-blind, actively controlled trial conducted in 32 communities in Anhui and Jiangsu provinces in China. The primary outcome was new-onset diabetes, defined as physician-diagnosed diabetes or use of glucose-lowering drugs during follow-up, or fasting glucose (FG) ≥ 126.0 mg/dL at the exit visit.

Results: During a median follow-up duration of 4.5 years, 287 (11.8%) participants developed diabetes. There was a significant positive association between baseline baPWV and the risk of new-onset diabetes (per SD increment; OR, 1.33; 95% CI 1.13, 1.56). Consistently, when baPWV was assessed as quartiles, a significantly higher risk of new-onset diabetes was found in participants in quartiles 2-4 (≥ 15.9 m/s; OR, 1.80; 95% CI 1.22, 2.65) compared with those in quartile 1 (< 15.9 m/s). The positive association was consistent in participants with (per SD increment; OR, 1.29; 95% CI 1.06, 1.56) or without (per SD increment; OR, 1.40; 95% CI 1.15, 1.71) impaired fasting glucose (IFG, FG ≥ 100.8 and < 126.0 mg/dL, P-interaction = 0.486).

Conclusions: In this sample of hypertensive patients, we found a significant positive association between baseline baPWV and the risk of new-onset diabetes. Clinical trial registration Trial registration: NCT00794885 (clinicaltrials.gov). Retrospectively registered November 20, 2008.

Keywords: Brachial–ankle pulse wave velocity; Fasting glucose; Hypertensive patients; New-onset diabetes.

Conflict of interest statement

XPX reports grants from the National Key Research and Development Program [2016YFE0205400, 2018ZX09739, 2018ZX09301034003]; the Science and Technology Planning Project of Guangzhou, China [201707020010]; the Science, Technology and Innovation Committee of Shenzhen [JSGG20170412155639040, GJHS2017031411 4526143] and the Economic, Trade and Information Commission of Shenzhen Municipality [20170505161556110, 20170505160926390].

XHQ reports grants from the National Natural Science Foundation of China [81730019] and Outstanding Youths Development Scheme of Nanfang Hospital, Southern Medical University [2017J009].

YBL reports grants from the President Foundation of Nanfang Hospital, Southern Medical University [2017C007, 2018Z009].

No other disclosures were reported.

Figures

Fig. 1
Fig. 1
Association between baseline brachial–ankle pulse wave velocity (baPWV) and new-onset diabetes during follow-up. *Adjusted for age, sex, study center, study treatment group, body mass index (BMI), heart rate, smoking, systolic blood pressure (SBP), fasting glucose (FG), total cholesterol (TC), creatinine, and folate at baseline, as well as time-averaged SBP during the treatment period
Fig. 2
Fig. 2
Risk of new-onset diabetes (expressed as OR and 95% CI) based on brachial–ankle pulse wave velocity (baPWV) quartiles. *Adjusted for age, sex, study center, study treatment group, body mass index (BMI), heart rate, smoking, systolic blood pressure (SBP), fasting glucose (FG), total cholesterol (TC), creatinine, and folate at baseline, as well as time-averaged SBP during the treatment period
Fig. 3
Fig. 3
Association between baseline brachial–ankle pulse wave velocity (baPWV) (per SD increment) and new-onset diabetes during follow-up in various subgroups. *Adjusted for age, sex, study center, study treatment group, body mass index (BMI), heart rate, smoking, systolic blood pressure (SBP), fasting glucose (FG), total cholesterol (TC), creatinine, and folate at baseline, as well as time-averaged SBP during the treatment period, if not be stratified

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