Cardiovascular Risk Profile and Clinical Characteristics of Diabetic Patients: A Cross-Sectional Study in China
Cardiovascular (CV) disease remains the leading cause of morbidity and mortality in adults with type 2 diabetes (T2D). This study aimed to evaluate the CV risk profile of Chinese patients with T2D based on the 2019 European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD) guidelines. The findings provide critical insights into the distribution of CV risk among Chinese T2D patients and highlight the need for tailored clinical strategies to mitigate this risk.
Background and Importance of the Study
Atherosclerotic cardiovascular disease (ASCVD) is the primary cause of death in individuals with T2D, with these patients facing two to four times higher risk of CV events compared to the general population. Given that China has the highest number of diabetes cases globally, the economic burden of CV disease in this population is substantial. Accurate assessment of CV risk is essential for guiding clinical decisions and implementing preventive measures.
Previous studies have demonstrated the utility of CV risk assessment in managing diabetes, hypertension, dyslipidemia, and obesity. However, existing risk prediction models, such as the US Pooled Cohort Equations (US-PCE) and the European Systematic Coronary Risk Estimation (SCORE), have limitations when applied to T2D patients. These models often fail to account for diabetes-specific factors such as disease duration and type. The 2019 ESC/EASD guidelines introduced a simplified CV risk classification system based on comorbidities and diabetes duration, aiming to improve risk stratification and guide treatment decisions.
Study Design and Methodology
This cross-sectional study analyzed data from 25,411 T2D patients enrolled in the China Cardiometabolic Registries 3B study. Participants were recruited from various hospital settings across China, including community hospitals, secondary/city-level hospitals, and tertiary teaching hospitals. Eligible patients were aged 18 years or older and had been diagnosed with T2D for at least six months. The study excluded pregnant women, individuals participating in other clinical trials, and those unable to provide a complete medical history.
The 2019 ESC/EASD guidelines were used to classify patients into three CV risk categories: very high risk, high risk, and moderate risk. An additional “unclear risk” category was created for patients who did not fit into the predefined groups. Established CV disease, target organ damage, and major risk factors such as age, hypertension, dyslipidemia, smoking, and obesity were assessed to determine risk classification.
Results and Key Findings
The study revealed that 65.6% of patients were classified as “very high risk,” 7.5% as “high risk,” and 0.6% as “moderate risk.” Notably, 26.4% of patients fell into the “unclear risk” category, indicating the need for further refinement of risk stratification criteria.
Very High Risk Group
Patients in the very high risk group had a mean age of 65.8 years and a mean diabetes duration of 9.0 years. Over 62% of these patients were overweight or obese, and 78.9% had three or more major risk factors. Nearly 40% of patients in this group had a diabetes duration exceeding 10 years.
High Risk Group
The high risk group comprised patients with a mean age of 61.4 years and a mean diabetes duration of 14.4 years. Approximately 45.9% of these patients were overweight or obese, with one-third having one risk factor and two-thirds having two risk factors.
Moderate Risk Group
Patients in the moderate risk group were significantly younger, with a mean age of 42.5 years and a mean diabetes duration of 3.1 years. This group had the lowest prevalence of obesity and other risk factors.
Unclear Risk Group
The unclear risk group included patients with a mean age of 55.3 years and a mean diabetes duration of 3.9 years. Over 95% of these patients had one or two risk factors, making it challenging to classify them into the predefined risk categories.
Stratification by Demographic and Clinical Factors
The distribution of CV risk categories varied significantly based on age, sex, body mass index (BMI), and diabetes duration.
Age and Sex
Elderly patients (≥65 years) were more likely to be classified as very high risk compared to younger patients. Men had a higher prevalence of very high risk (71.3%) than women (60.5%). Conversely, women were more likely to be classified as high risk (9.2%) compared to men (5.5%).
BMI
Obesity was strongly associated with very high CV risk, with 89.6% of obese patients falling into this category. Overweight patients also had a high prevalence of very high risk (62.9%).
Diabetes Duration
The proportion of patients classified as very high risk increased significantly with longer diabetes duration. For example, 52.3% of patients with a diabetes duration of less than one year were classified as very high risk, compared to 86.1% of those with a duration of 20 years or more.
Clinical Implications
The high prevalence of very high and high CV risk among Chinese T2D patients underscores the urgent need for comprehensive management strategies. The study highlights the importance of addressing multiple risk factors simultaneously, including glycemic control, blood pressure management, lipid-lowering therapy, and weight management. Intensive and novel therapies, such as PCSK9 inhibitors, may be considered for patients in the very high risk category who fail to achieve target goals with conventional treatments.
The findings also emphasize the need for early intervention in younger patients and those with newly diagnosed diabetes. While these patients may not initially fall into the very high or high risk categories, they are at increased lifetime risk for CV disease and may benefit from aggressive risk factor management.
Limitations and Future Directions
This study has several limitations. First, its cross-sectional design precludes the assessment of predictive performance for the 2019 ESC/EASD risk classification system. Second, the analysis did not account for changes in risk factors and treatment patterns over time. Third, the definitions of risk factors in the 2019 ESC/EASD guidelines were not tailored to the Chinese population, potentially affecting the accuracy of risk stratification.
Future research should focus on developing and validating CV risk prediction models specifically for Chinese T2D patients. Prospective studies are needed to evaluate the long-term implications of the 2019 ESC/EASD risk classification system and its impact on clinical outcomes.
Conclusion
This study provides a comprehensive assessment of CV risk among Chinese T2D patients based on the 2019 ESC/EASD guidelines. The high prevalence of very high and high CV risk highlights the need for targeted interventions to reduce the burden of CV disease in this population. The findings also underscore the importance of refining risk stratification criteria, particularly for patients in the unclear risk category. By addressing these challenges, healthcare providers can improve the management of CV risk in Chinese T2D patients and ultimately reduce morbidity and mortality.
doi.org/10.1097/CM9.0000000000001741
Was this helpful?
0 / 0