1516-P: Microvascular Burden Predicts All-Cause Mortality, Major Vascular Outcomes, and ESRD in Type 2 Diabetes

Abstract

Microvascular complications (MC) affect CV risk and mortality in T2D. We explored the association of cumulative burden of retinopathy, nephropathy and peripheral neuropathy with mortality, CV events and ESRD in a single-centre, observational study involving 986 T2D over a 12.9±2.7 yrs follow-up. Vital status and rates of outcomes were censored on December 2017. The cohort included 491 (49.8%), 318 (32.3%), 135 (13.7%) and 42 (4.3%) people with no, 1, 2 or 3 MC. All-cause mortality (23.3%) increased from no-MC (15.3%) to 1 MC (23.3%, HR 1.60; 95%CI 1.16-2.20), 2 MC (41.5%, 3.19; 2.25-4.51) and 3 MC (59.5%, 5.32; 3.38-8.36; p<0.0001). After adjustments, HRs were: 1 MC, 1.21 (0.87-1.69); 2 MC, 1.72 (1.15-2.56) and 3 MC, 3.17 (1.89-5.33, p<0.0001). Irrespective of number of baseline CV risk factors not at target (HbA1c ≥7%, LDL ≥100 mg/dl, BP ≥140/90 mmHg), age and sex adjusted HRs raised with MC (p<0.0001). CV events occurred in 276 T2D (28.4%). Incidence raised with MC: no-MC, 20.8%; 1 MC, 31.3% (HR 1.65; 1-25-2.18); 2 MC, 42.7% (2.77; 2.00-3.85); 3 MC, 50.0% (3.78; 2.36-6.05, p<0.0001). After adjustments, HRs for CV events were: 1 MC, 1.37 (1.03-1.82); 2 MC, 1.61 (1.12-2.30) and 3 MC, 2.42 (1.48-3.99, p<0.0001). Rate of heart failure hospitalization (hHF) was 3.3% in no-MC, 11.5% in 1 MC (HR 3.19; 1.83-5.56), 17.6% in 2 MC (5.68; 3.09-10.45) and 14.3% (5.00; 2.00-12.54) in 3 MC (p<0.0001). After adjustments, rate of hHF raised in 1 MC (2.28; 1.30-4.01), 2 MC (3.38; 1.79-6.40) and 3 MC (3.02; 1.19-7.65). Also ESRD raised with MC: no-MC, 4.9%; 1 MC, 6.7% (HR 1.44; 0.80-2.59); 2 MC, 11.5% (2.76; 1.45-5.27); 3 MC, 26.2% (7.67; 3.75-15.70; p<0.0001). After adjustments, ESRD raised with 2 MC (HR 2.34; 1.21-4.53) and 3 MC (6.41; 3.19-13.16, p<0.0001). Incidence of CV events, hHF, and ESRD raised with number of MC after stratification for risk factors not at target (p<0.0001). In T2D, the cumulative burden of MC predicts mortality, CV events, hHF and ESRD, offering an accessible tool for improving risk prediction. Disclosure M. Garofolo: None. E. Gualdani: None. R. Giannarelli: None. D. Lucchesi: None. R. Miccoli: None. P. Francesconi: None. S. Del Prato: Advisory Panel; Self; Applied Therapeutics, AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis Pharmaceuticals Corporation, Novo Nordisk A/S. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Takeda Pharmaceutical Company Limited. G. Penno: None.