The researchers reported that for diabetes, the risk of mortality increased from a hazard ratio (HR) of 1.37 for 0-5 years to 1.91 for 10 years or more. Similarly, they observed that the risk associated with hypertension also rose, with the HR increasing from 1.38 to 1.51. They further added that the risk of MACCE also increased, from 1.23 to 1.50 for diabetes and from 1.27 to 1.39 for hypertension. Additionally, the combination of both conditions resulted in even higher risks.
The link between patient outcomes and the cumulative effects of cardiovascular risk factors over time is well acknowledged, but its full impact has not been quantified. Mana Jameie, Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran, and colleagues aimed to address this gap by quantitatively assessing the effects of the duration of diabetes and hypertension, both individually and in combination, on outcomes following CABG.
For this purpose, the researchers conducted a single-center cohort study involving 10,803 patients who underwent coronary angiography followed by isolated CABG between 2007 and 2017, with a median follow-up of 111.3 months. The study focused on all-cause mortality and major adverse cardiocerebrovascular events as outcomes. Cox regression analyses were used to evaluate the impact of the duration of diabetes and hypertension (<5 years, 5-10 years, ≥10 years) on these outcomes, both in the overall cohort and when stratified by the presence of these risk factors.
The key findings of the study were as follows:
- The study included 10,803 patients, with an average age of 65.56 years. Of these, 75.3% were male, 40.1% had diabetes, and 64.1% had hypertension.
- The risk of study outcomes, including all-cause mortality and major adverse cardiocerebrovascular events (MACCE), increased with the duration of diabetes. The adjusted hazard ratio for all-cause mortality increased from 1.37 for diabetes duration of 0-5 years to 1.91 for ≥10 years, and for MACCE, it increased from 1.23 to 1.59.
- When stratified by hypertension status, the association between shorter diabetes duration and outcomes became insignificant in non-hypertensive patients, but it remained significant in those with hypertension.
- The risk of all-cause mortality and MACCE also increased with longer hypertension duration. The adjusted hazard ratio for mortality rose from 1.38 for less than 5 years of hypertension to 1.51 for more than 10 years, while the risk for MACCE increased from 1.27 to 1.39.
- This increased risk was more pronounced when both diabetes and hypertension coexisted.
The researchers concluded that "the duration of risk factor exposure plays a crucial role in assessing patient risk." They emphasized that "these findings offer valuable insights that could improve current risk assessment tools and help in developing more personalized preventive strategies for patients."
Reference:
Jameie, M., Saeedian, B., Pashang, M., Babajani, N., Vakili, A., Chichagi, F., Rad, S. N., Jalali, A., Askari, M. K., Toursavadkohi, S., Syed, M., Hernandez, A. V., Mansourian, S., & Hosseini, K. The association between diabetes and hypertension time course, their cumulative co-exposure, and post-coronary artery bypass graft outcomes. American Journal of Hypertension. https://doi.org/10.1093/ajh/hpaf074
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