Clinical characteristics and outcomes of lean diabetes mellitus in patients with moderate and severe aortic stenosis.
Lean diabetes mellitus (DM), defined as the presence of DM in patients with low-normal body mass index (BMI), is an emerging concept associated with poorer cardiovascular and all-cause outcomes. We aimed to describe the clinical characteristics of aortic stenosis (AS) patients with concomitant lean DM, an understudied metabolic profile, and to evaluate its clinical relevance.
In this retrospective cohort study involving 315 moderate and severe AS patients, identified from an echocardiographic database at a tertiary medical centre between September 2011 and December 2015, patients were stratified based on obesity (BMI ≥ or <23 kg/m2) and DM status. Outcomes were analysed over a follow-up period of 3.0 ± 2.1 years.
The mean age was 72.2 ± 13.1 years old, and 52.4% were female. Among the 315 patients with moderate and severe AS, 47 (14.9%) were lean DM, 24.4% were lean without DM, 30.0% were non-lean with DM, and 33.7% were non-lean without DM. Compared with non-lean DM patients, AS patients with lean DM were older (p < 0.001), and had a greater burden of cardiovascular co-morbidities, such as hypertension (p < 0.001) and coronary artery disease (p < 0.001). Lean DM was associated with an increased hazard of major adverse cardiovascular events (MACEs) on multivariable analysis (adjusted hazard ratio 1.81, 95% confidence interval 1.01-3.27, p = 0.046), after adjusting for demographics, co-morbidities, left ventricular ejection fraction, and AS severity.
The presence of lean DM in moderate and severe AS patients portends a higher risk of MACE, and represents a high-risk phenotype that may warrant closer surveillance and earlier intervention.
In this retrospective cohort study involving 315 moderate and severe AS patients, identified from an echocardiographic database at a tertiary medical centre between September 2011 and December 2015, patients were stratified based on obesity (BMI ≥ or <23 kg/m2) and DM status. Outcomes were analysed over a follow-up period of 3.0 ± 2.1 years.
The mean age was 72.2 ± 13.1 years old, and 52.4% were female. Among the 315 patients with moderate and severe AS, 47 (14.9%) were lean DM, 24.4% were lean without DM, 30.0% were non-lean with DM, and 33.7% were non-lean without DM. Compared with non-lean DM patients, AS patients with lean DM were older (p < 0.001), and had a greater burden of cardiovascular co-morbidities, such as hypertension (p < 0.001) and coronary artery disease (p < 0.001). Lean DM was associated with an increased hazard of major adverse cardiovascular events (MACEs) on multivariable analysis (adjusted hazard ratio 1.81, 95% confidence interval 1.01-3.27, p = 0.046), after adjusting for demographics, co-morbidities, left ventricular ejection fraction, and AS severity.
The presence of lean DM in moderate and severe AS patients portends a higher risk of MACE, and represents a high-risk phenotype that may warrant closer surveillance and earlier intervention.
Authors
Leow Leow, Ong Ong, Thong Thong, Seah Seah, Ho Ho, Tan Tan, Quek Quek, Kong Kong, Yeo Yeo, Sia Sia, Poh Poh
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