Abstract
BackgroundAmong people with type 2 diabetes the relationship between central obesity and cardiovascular mortality has not been definitely assessed. Moreover, NT-proBNP is negatively associated with central obesity, but no study has examined their combined effect on survival. We have examined these issues in a well-characterized population-based cohort.Methods and FindingsSurvival data of 2272 diabetic people recruited in 2000 who had no other chronic disease have been updated to 31 December 2006. NT-proBNP was measured in a subgroup of 1690 patients. Cox proportional hazards modeling was employed to estimate the independent associations between cardiovascular and all-cause mortality and waist circumference. Mean age was 67.9 years, 49.3% were men. Both age and NT-proBNP were negatively correlated with waist circumference (r = −0.11, p<0.001 and r = −0.07, p = 0.002). Out of 2272 subjects, 520 deaths (221 for CV mortality) occurred during a median follow-up of 5.4 years. Central obesity was not associated with CV mortality (hazard ratio, HR, adjusted for age, sex, diabetes duration, 1.14, 95% CI 0.86–1.52). NTproBNP was a negative confounder and age a strong modifier of this relationship (p for interaction<0.001): age<70 years, fully adjusted model HR = 3.52 (1.17–10.57) and age ≥70 years, HR = 0.80 (0.46–1.40). Respective HRs for all-cause mortality were 1.86 (1.03–3.32) and 0.73 (0.51–1.04).ConclusionsIn diabetic people aged 70 years and lower, central obesity was independently associated with increased cardiovascular mortality, independently of the negative effect of NT-proBNP. In contrast, no effect on 6-years survival was evident in diabetic people who have yet survived up to 70 years.
Highlights
Obesity is a strong predictor of diabetes incidence, while the association between obesity and mortality is more controversial, most of studies showing an inverse relationship between obesity and mortality and a modification effect of age [1,2,3,4,5,6,7,8].Waist circumference positively correlates with abdominal fat mass, providing a simple and reliable assessment of central obesity, which is associated with increased mortality risk
In diabetic people aged 70 years and lower, central obesity was independently associated with increased cardiovascular mortality, independently of the negative effect of NT-proBNP
No effect on 6-years survival was evident in diabetic people who have yet survived up to 70 years
Summary
Obesity is a strong predictor of diabetes incidence, while the association between obesity and mortality is more controversial, most of studies showing an inverse relationship between obesity and mortality and a modification effect of age [1,2,3,4,5,6,7,8].Waist circumference positively correlates with abdominal fat mass, providing a simple and reliable assessment of central obesity, which is associated with increased mortality risk. Prospective data on the predictive role of central obesity on cardiovascular mortality of diabetic patients are very limited [9]. No prospective study has provided estimates of CV mortality adjusted for NTproBNP, so that the final effect of central obesity on mortality risk has been probably biased downward. Both in diabetic and non-diabetic patients age has a modification effect on the relationship between BMI and mortality, and a similar pattern could affect the relationship between central obesity and mortality [3,4,5,6,7,14]. We have examined these issues in a well-characterized population-based cohort
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