CHARACTERISTIC FEATURES OF PROGRESSIVE CARDIOVASCULAR DISEASE IN TYPE 2 DIABETIC PATIENTS WITHOUT HYPERTENSION-10 YEARS FOLLOW-UP: PP.17.119

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Aim: Incidence of cardiovascular disease (CVD) in diabetes is related to not only glucose levels, but also multiple risk factors. Hypertension is a common comorbidity in patients with diabetes, and greatly increases the risk of CVD. To know characteristic features of progressive CVD in diabetes, we investigate relationship between incidence of CVD and risk factors and left ventricular (LV) function at baseline and progression of hypertension in type 2 diabetic patients without hypertension with 10-year follow-up. Subjects and Methods: In 1998 and 1999, 97 type 2 diabetic patients without hypertension who did not have both overt cardiac disease and macro-albuminuria were enrolled. Eighty-four patients (male 54, age 56 (8) years (mean (SD)), BMI 23.0 (2.7) kg/m2) were completed 10-year follow-up. Clinical characteristics and echocardiography was performed at baseline. LV internal diameter was measured by M-mode echocardiography, and fractional shortening (FS) and LV mass were also calculated. LV systolic function was assessed by FS, and LV diastolic function was assessed by the ratio between the peak diastolic velocity and the peak atrial systolic velocity (E/A) and isovolumic relaxation time (IVRT) with Doppler examination. Hypertension was defined that patients with 140 and/or 85 mmHg and more, or use of antihypertensive medications. The primary outcome was a composite of nonfatal myocardial infarction (MI), nonfatal stroke, or death from cardiovascular causes. Results: During 10-year follow-up, 14 patients (17%) had CVD events (8 patients had nonfatal MI, 4 angina pectoris, 1 heart failure, and 1nonfatal stroke.)(CVD group), and 4 patients died of cancer and leukemia, and 66 patients did not have any cardiovascular diseases (N group). CVD group had older age (60 (6) vs 55 (6) years, p < 0.05), elevated systolic blood pressure (130 (10) vs 121 (11) mmHg, p < 0.01), higher LDL cholesterol level (141 (20) vs 123 (36) mg/dl, p < 0.05), and higher presence of retinopathy (64 vs 35 %, p < 0.05) at baseline than N group. During 10 years, 54% of CVD group had newly diagnosed hypertension as compared to 23% in N group, but there were not significant differences between CVD and progression of hypertension. For LV function, CVD group had decreased LV diastolic function as compared to N group (IVRT 78.5 (16.3) vs 70.6 (10.7) ms, p < 0.05). In logistic regression analysis, independent risk factors for CVD were presence of retinopathy (3.059 (1.309–7.153); OR (95% CI), p <0.005), extended IVRT (1.050 (0.999–1.109), p = 0.05), systolic blood pressure at baseline (1.062 (0.998–1.113), p = 0.059). Conclusions: During 10-year follow-up, 17% of type 2 diabetic patients without hypertension had CVD. It suggests that LV diastolic dysfunction is a subclinical important factor for incidence of CVD, and to preserve lower blood pressure level may also be important to prevent CVD in type 2 diabetic patients.