Diabesity and cardiovascular mortality in a prospective population cohort followed for more than 20 years

Abstract

Introduction

Control of the main cardiovascular risk factors had succeeded in reducing cardiovascular diseases (CVD). However, the general increase in the prevalence of type 2 diabetes mellitus (DM2) and obesity has slowed this decline. Both CVRFs are strongly associated, and the term diabesity has been coined to refer to this relationship. The main objective of this study was to assess the influence of diabesity on cardiovascular mortality.

Methods

Prospective cohort study involving 1246 individuals (54.3% women) followed for 20.9 years (SD = 7.31) and selected by random two-stage sampling in a province in southeastern Spain. Diabesity was defined as the combination of DM2 with overweight and obesity. Survival curves (Kaplan-Meier) were calculated and two Cox regression models were used, one unadjusted and the other adjusted by the main explanatory variables in which the diabesity variable consisted of 6 categories (normal weight, overweight, obesity, normal weight + DM2, overweight + DM2 and obesity + DM2).

Results

There were 95 deaths due to CV causes (7.6% of the total; 6.2% women and 9.3% men; P = .01). After adjustment, the combination of DM2 and overweight increased the incidence of cardiovascular mortality by 133% (HR = 2.33; 95% CI: 1.18-4.58; P = .014) and the combination of DM2 and obesity by 49% (HR = 1.49; 95% CI: 0.64−3.45; P = .351), not reaching statistical significance in the latter case.

Conclusions

In the general population, the results of our study show that the combination of overweight and DM2 is associated with higher CV mortality. It seems a priority to intervene intensively in the control of both overweight and DM2.

Resumen

Introducción

El control de los factores de riesgo cardiovascular había reducido las enfermedades cardiovasculares (ECV). Sin embargo, el aumento de la prevalencia de la diabetes mellitus tipo 2 (DM2) y la obesidad ha disminuido esta desaceleración. La asociación de ambos responde al término diabesidad. El objetivo principal del presente estudio ha sido valorar la influencia de la diabesidad en la mortalidad de causa cardiovascular (CV).

Métodos

Estudio de cohortes prospectivo. Han participado 1246 individuos (54,3% mujeres) seguidos durante 20,9 años (DE = 7,31) seleccionados mediante muestreo aleatorio y bietápico en una provincia del sudeste de España. Se ha definido la diabesidad como la combinación de la DM2 con el sobrepeso y la obesidad. Se calcularon curvas de supervivencia (Kaplan-Meier) y se utilizaron dos modelos de regresión de Cox, uno sin ajustar y el otro ajustado, en el que la variable diabesidad constaba de 6 categorías (normopeso, sobrepeso, obesidad, normopeso + DM2, sobrepeso + DM2 y obesidad + DM2).

Resultados

Se produjeron 95 fallecimientos por ECV (7,6% del total; 6,2% mujeres y 9,3% varones; P = ,01). Después del ajuste, la combinación DM2 y sobrepeso aumentó la incidencia de la mortalidad CV un 133% (HR = 2,33; IC 95%: 1,18−4,58; P = ,014) y la combinación DM2 y obesidad un 49% (HR = 1,49; IC del 95%: 0,64−3,45; P = ,351), no alcanzandose significación estadística en este último caso.

Conclusiones

En población general, los resultados de nuestro estudio muestran que la combinación sobrepeso + DM2 está asociada a mayor mortalidad CV. Parece prioritario intervenir con intensidad en el control tanto del sobrepeso como de la DM2.