Association of predicted lean body mass and fat mass with cardiovascular events in patients with type 2 diabetes mellitus

Abstract

Background: Previous studies have found that predicted fat mass and lean body mass may act differently on adverse events. However, the cardiovascular prognostic value of lean body mass and fat mass in patients with type 2 diabetes mellitus (T2DM) has not yet been investigated. We sought to investigate the relation between predicted lean body mass or fat mass and the risk of cardiovascular disease in patients with T2DM.

Methods: We conducted a post hoc analysis of data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study to investigate the relation between the predicted lean body mass or fat mass and major adverse cardiovascular events in patients with T2DM. We used sex-specific quartiles of predicted lean body mass index (BMI; kg/m2) and fat mass index (kg/m2). We defined a major adverse cardiovascular event as a composite of nonfatal myocardial infarction, nonfatal stroke or death from cardiovascular causes.

Results: After a mean follow-up period of 8.8 years, we found that a major cardiovascular event occurred in 1801 of 10 251 patients (17.8%). Predicted lean BMI was not associated with major cardiovascular events (p = 0.34). Compared with patients in the first quartile (incidence rate 16.4%; 17.2%, 17.5% and 19.8% for the second, third and four quartiles, respectively) of predicted fat mass index, those in the fourth quartile had a hazard ratio of 1.53 (95% confidence interval 1.23-1.91).

Interpretation: In patients with T2DM, we found that predicted fat mass had a strong positive association with a higher risk of a major adverse cardiovascular event. Increasing lean body mass did not have a protective role. Trial registration: ClinicalTrials.gov., no. NCT00000620.

Conflict of interest statement

Competing interests: None declared.

© 2019 Joule Inc. or its licensors.

Figures

Figure 1:

Hazard ratios per 1 standard deviation–increase in predicted lean body mass index for major adverse cardiovascular events. Each stratification was adjusted for all factors in model 4 (i.e., age, ethnicity, sex, treatment group, hypertension, hyperlipidemia, smoking, previous cardiovascular disease, previous heart failure, height and fasting blood glucose) except for the stratification factor itself. Note: CI = confidence interval, CVD = cardiovascular disease, HR = hazard ratio.

Figure 2:

Hazard ratios per 1 standard deviation–increase in predicted fat mass index for major adverse cardiovascular events. Each stratification was adjusted for all factors in model 4 (i.e., age, ethnicity, sex, treatment group, hypertension, hyperlipidemia, smoking, previous cardiovascular disease, previous heart failure, height and fasting blood glucose) except for the stratification factor itself. Note: CI = confidence interval, CVD = cardiovascular disease, HR = hazard ratio.