Abstract P443: Association of Peripheral Neuropathy With All-cause and Cardiovascular Mortality in US Adults

Abstract

Background: Peripheral neuropathy (PN) is common in the general US adult population, especially in older adults even in the absence of diabetes. However, the clinical sequelae of PN have not been quantified in a nationally representative sample. We aimed to assess the associations of prevalent PN with all-cause and cardiovascular mortality using data from the National Health and Nutrition Examination Survey(NHANES). Methods: Prospective cohort analysis of 7,137 participants from NHANES (aged ≥40 yrs) who underwent standardized PN testing at baseline (1999-2004). We used survival analysis methods and Cox regression to evaluate the associations of PN with all-cause and cardiovascular mortality. Cox models were adjusted for demographic and cardiovascular risk factors. Results: The overall prevalence of PN was 17.7% (29.9% in adults with diabetes and 15.2% in adults without diabetes). In age-adjusted Kaplan-Meier analyses (median follow-up 13 yrs), the risk of all-cause and cardiovascular mortality was highest among adults with PN and diabetes, but PN was also associated with excess mortality risk in the absence of diabetes ( Figure ). After multivariable adjustment, PN remained significantly associated with all-cause and cardiovascular mortality in participants with diabetes ( Figure) , although the association of PN with cardiovascular mortality was largely driven by participants with long-standing diabetes ≥10 yrs (HR 4.53, 95%CI 2.34-8.78). In participants without diabetes, PN was moderately associated with both all-cause and cardiovascular mortality after adjustment ( Figure ). Conclusions: PN was associated with mortality in the US population regardless of diabetes status, suggesting that screening for PN may be important for older adults both with and without diabetes. Adults with long-standing diabetes and PN were at a substantially elevated risk of cardiovascular-related mortality, potentially reflecting a higher burden of concomitant diabetic autonomic neuropathy in this high-risk population.