Bas T Franssens1, Yolanda van der Graaf2, L Jaap Kappelle3, Jan Westerink1, Gert J de Borst4, Maarten J Cramer5, Frank L J Visseren6. 1. Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands. 2. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. 3. Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands. 4. Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands. 5. Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands. 6. Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands f.l.j.visseren@umcutrecht.nl.
Abstract
OBJECTIVE: To quantify the role of BMI and metabolic dysfunction in the risk of development of type 2 diabetes in patients at high risk or with manifest vascular disease. RESEARCH DESIGN AND METHODS: A total of 6,997 patients participating in the prospective Secondary Manifestations of ARTerial disease (SMART) cohort study were classified according to BMI and metabolic dysfunction, defined as three or more of the modified National Cholesterol Education Program (NCEP) metabolic syndrome criteria (waist circumference replaced by hs-CRP ≥2 mg/L). Risk of type 2 diabetes (assessed with biannually questionnaires) was estimated with Cox proportional hazards analysis. RESULTS: During a median follow-up of 6.0 years (interquartile range 3.1-9.1 years), 519 patients developed type 2 diabetes (incidence rate 12/1,000 person-years). In the absence of metabolic dysfunction (≤2 NCEP criteria), adiposity increased the risk of type 2 diabetes compared with normal-weight patients (HR 2.5 [95% CI 1.5-4.2] for overweight and HR 4.3 [95% CI 2.2-8.6] for obese patients). In the presence of metabolic dysfunction (≥3 NCEP criteria), an increased risk of type 2 diabetes was observed in patients with normal weight (HR 4.7 [95% CI 2.8-7.8]), overweight (HR 8.5 [95% CI 5.5-13.4]), and obesity (HR 16.3 [95% CI 10.4-25.6]) compared with normal-weight patients without metabolic dysfunction. CONCLUSIONS: Adiposity, even in the absence of metabolic dysfunction, is a risk factor for type 2 diabetes. Moreover, presence of metabolic dysfunction increases the risk of type 2 diabetes in all BMI categories. This supports the assessment of adiposity and metabolic dysfunction in patients with vascular disease or at high risk for cardiovascular events.
OBJECTIVE: To quantify the role of BMI and metabolic dysfunction in the risk of development of type 2 diabetes in patients at high risk or with manifest vascular disease. RESEARCH DESIGN AND METHODS: A total of 6,997 patients participating in the prospective Secondary Manifestations of ARTerial disease (SMART) cohort study were classified according to BMI and metabolic dysfunction, defined as three or more of the modified National Cholesterol Education Program (NCEP) metabolic syndrome criteria (waist circumference replaced by hs-CRP ≥2 mg/L). Risk of type 2 diabetes (assessed with biannually questionnaires) was estimated with Cox proportional hazards analysis. RESULTS: During a median follow-up of 6.0 years (interquartile range 3.1-9.1 years), 519 patients developed type 2 diabetes (incidence rate 12/1,000 person-years). In the absence of metabolic dysfunction (≤2 NCEP criteria), adiposity increased the risk of type 2 diabetes compared with normal-weight patients (HR 2.5 [95% CI 1.5-4.2] for overweight and HR 4.3 [95% CI 2.2-8.6] for obesepatients). In the presence of metabolic dysfunction (≥3 NCEP criteria), an increased risk of type 2 diabetes was observed in patients with normal weight (HR 4.7 [95% CI 2.8-7.8]), overweight (HR 8.5 [95% CI 5.5-13.4]), and obesity (HR 16.3 [95% CI 10.4-25.6]) compared with normal-weight patients without metabolic dysfunction. CONCLUSIONS: Adiposity, even in the absence of metabolic dysfunction, is a risk factor for type 2 diabetes. Moreover, presence of metabolic dysfunction increases the risk of type 2 diabetes in all BMI categories. This supports the assessment of adiposity and metabolic dysfunction in patients with vascular disease or at high risk for cardiovascular events.
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