Abstract 3690: Adverse Effect of New-Onset Diabetes Mellitus on Cardiovascular Events: A 6 Years Prospective Study in a Cohort of 1446 Greek Hypertensives
Introduction: The impact of new-onset Diabetes mellitus (DM) on cardiovascular outcome in hypertensive patients still remains a controversial issue.
Hypothesis: New onset diabetes mellitus in treated non-diabetics essential hypertensive subjects may related to increased risk for major cardiovascular events, such as coronary artery disease (CAD) and stroke.
Methods: Towards this end, we followed up 1446 non-diabetic essential hypertensive patients (aged 54.2 years, body mass index 28.4 kg/m2, office blood pressure 146/93 mmHg, duration of hypertension 6.1 years) for a mean period of 6 years. Based on the development of new cases of DM (defined as fasting plasma glucose ≥ 126 mg/dl) the cohort was divided into two subgroups and examined for the presence of CAD (defined as the presence at least one of the followings: myocardial infarction, PTCA, CABG, positive coronary angiography or exercise stress test) and stroke (defined as rapid onset of new neurological deficit persisting at least 24 hours unless death occurred). Odds ratios (OR) and confidence intervals (CI) were calculated for each group using multivariate logistic regression analyses.
Results: During follow-up period, in the entire study population, the incidence of new or recurrent cases of CAD, stroke and new-onset DM was 7.3%, 6.2% and 11.5% respectively. Taking into consideration the baseline measurements, the independent predictors for new cases of DM were family history of DM, age, body mass index, waist to hip ratio, serum glucose and triglyceride levels (p< 0.001 for all cases), as well as systolic blood pressure (p=0.018) and previous antihypertensive treatment (p=0.02). Hypertensive subjects with new onset DM, compared to those who remained non-diabetics, exhibited higher incidence of stroke (10.2% vs 4.4%, p=0.001, OR 2.48, 95% CI: 1.41 to 4.38), especially of the ischemic type (7.2% vs 1.6%, p<0.001, OR 4.88, 95% CI: 2.34 to 10.17). Contrariwise, the two subgroups did not differ regarding the incidence of CAD (6.6% vs 5.2%, p=0.458).
Conclusions: The development of new onset DM in treated essential hypertensives is accompanied by increased incidence of stroke, especially of ischemic type. However, the risk of CAD seems not be directly linked with de-novo presence of DM.