| Objective:Obesity is a risk factor for cardiovascular events in patients with type 2 diabetes,but different patients have different cardiovascular risks even with the same BMI.The aim of this study was to investigate whether the risk of cardiovascular events over the next 10 years varies with BMI in patients with type 2 diabetes,with different ages and genders.And body composition(limb muscle,trunk fat)to better understand the potential associations between BMI and cardiovascular events in patients with type 2diabetes over the next 10 years.Methods:This study is a cross-sectional study.During the period from January 9,2012 to September 30,2019,4968 diabetes patients who treated in the endocrinology department of the First Affiliated Hospital of Fujian Medical University were selected.At last 3315 patients with type 2 diabetes(including 1710 males and 1605 females)who met the requirements and kept stable weight in recent years were divided into four groups: male < 60 years old,male ≥60 years old,female < 60 years old and female ≥60years old.Their height,weight,blood pressure,fasting plasma glucose(FPG),triglyceride(TG),total cholesterol(TC),high density lipid-cholesterol(HDL-C),low density lipid-cholesterol(LDL-C),routine hematological and biochemical parameters,glycosylated hemoglobin A-1c(Hb A1c),bone mineral density and other indicators were collected separately.SPSS V22.0 and R V4.0.3 were used for statistical analysis.Result:1.There were no statistically significant differences in BMI(P=0.473)and HDL(P=0.426)between male T2 DM patients aged < 60 and ≥60 years,but there were statistically significant differences in smoking,waist-hip ratio,limb muscle,body fat,systolic blood pressure,diastolic blood pressure,diabetic course,Hb A1 c,FPG,TC,TG and LDL-C(P < 0.05).There were no statistically significant differences in smoking(P= 0.25),TC(P = 0.496),TG(P = 0.633)and LDL-C(P = 0.691)between female T2 DM patients aged < 60 and ≥60 years,but there were statistically significant differences in BMI,waist hip ratio,limb muscles,body fat,systolic pressure,diastolic blood pressure,diabetes duration,Hb A1 c,FPG,HDL-C(P < 0.05).When age ≥60years,the Framingham risk score and the risk of cardiovascular events over the next 10 years were significantly higher for both men and women than for those younger than 60 years,and the proportion of CVD risk in the high-risk group increased significantly.2.According to Pearson and Spearman correlation univariate analysis,age,BMI,waist to hip ratio,systolic blood pressure,diastolic blood pressure,course of diabetes,TC,TG,LDL-C were significantly positively correlated with Framingham risk score(all r > 0 and P < 0.05).There was a negative correlation between Hb A1 c,FPG,HDL-c and Framingham risk score(r < 0 and P < 0.05).There was no linear relationship between smoking and Framingham risk score(P=0.192).3.There was a linear correlation between BMI and Framingham risk score in male and female participants aged < 60 years and ≥60 years,respectively,as assessed by Pearson correlation and univariate linear regression(both r >0 and P < 0.05).4.Restricted cubic spline analysis showed that the 10-year risk of CVD increased with BMI in both men and women with type 2 diabetes when age < 60 years.When≥60 years,the next 10 years CVD risk of female patients with type 2 diabetes was still increased with the increase of BMI,while the next 10 years CVD risk of male patients with type 2 diabetes was increased with the increase of BMI < 30,but when the BMI was ≥30,the incidence of CVD risk in the next 10 years was wirelessly close to 1.5.There was no mediating effect on BMI and FRS in limbs muscle(P=0.351)or trunk fat(P=0.506)when women were < 60 years old.BMI(β=0.223,P < 0.05)and limb muscle(β=-0.121,P < 0.05)had an effect on FRS in women ≥60 years old,suggesting that the effect of BMI on FRS could be explained by limb muscle.When men < 60 years of age,BMI(β=0.017,P < 0.05)and trunk fat(β=0.128,P < 0.05)had an effect on FRS,suggesting that the effect of BMI on FRS could be explained by trunk fat.BMI(β=0.223,P < 0.05)and limb muscle(β=-0.121,P < 0.05)had effects on FRS in women aged ≥60 years,suggesting that the effect of BMI on FRS could be explained by the mediating effect of limb muscle.When men < 60 years of age,BMI(β=0.017,P< 0.05)and trunk fat(β=0.128,P < 0.05)had an effect on FRS,suggesting that the effect of BMI on FRS could be explained by the mediating effect of trunk fat.BMI(β=0.0.09,P < 0.05)and trunk fat(β=0.181,P < 0.05)had effects on FRS in men ≥60years old,suggesting that the effect of BMI on FRS could be explained by the mediating effect of trunk fat.Conclusion:Whatever age,patients with type 2 diabetes,with the increase of BMI,the next 10 years an increased risk of cardiovascular events,so we suggest that patients with type 2diabetes,especially in obese and overweight people to reduce their risk of cardiovascular events in the next 10 years,should be positive to weight control,at the same time,women should be to increase the limb muscle mass as the goal,men should aim to reduce body fat. |
