Diabetes Metab J.  2025 Mar;49(2):298-310. 10.4093/dmj.2024.0239.

Does 10-Year Atherosclerotic Cardiovascular Disease Risk Predict Incident Diabetic Nephropathy and Retinopathy in Patients with Type 2 Diabetes Mellitus? Results from Two Prospective Cohort Studies in Southern China

• Chen J
• Li YT
• Niu Z
• He Z
• Xie YJ
• Hernandez J
• Huang W
• Wang HH
• on Behalf of the Guangzhou Diabetic Eye Study Group

• KMID: 2565352
• DOI: http://doi.org/10.4093/dmj.2024.0239

Abstract

Background
Diabetic macrovascular and microvascular complications often coexist and may share similar risk factors and pathological pathways. We aimed to investigate whether 10-year atherosclerotic cardiovascular disease (ASCVD) risk, which is commonly assessed in diabetes management, can predict incident diabetic nephropathy (DN) and retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).
Methods
This prospective cohort study enrolled 2,891 patients with clinically diagnosed T2DM who were free of ASCVD, nephropathy, or retinopathy at baseline in the Guangzhou (2017–2022) and Shaoguan (2019–2021) Diabetic Eye Study in southern China. The 10-year ASCVD risk was calculated by the Prediction for ASCVD Risk in China (China-PAR) equations. Multivariable- adjusted Cox proportional hazard models were developed to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). The area under the receiver operating characteristic curve (AUC) was used to evaluate predictive capability.
Results
During follow-up, a total of 171 cases of DN and 532 cases of DR were documented. Each 1% increment in 10-year ASCVD risk was associated with increased risk of DN (pooled HR, 1.122; 95% CI, 1.094 to 1.150) but not DR (pooled HR, 0.996; 95% CI, 0.979 to 1.013). The model demonstrated acceptable performance in predicting new-onset DN (pooled AUC, 0.670; 95% CI, 0.628 to 0.715). These results were consistent across cohorts and subgroups, with the association appearing to be more pronounced in women.
Conclusion
Ten-year ASCVD risk predicts incident DN but not DR in our study population with T2DM. Regular monitoring of ASCVD risk in routine diabetes practice may add to the ability to enhance population-based prevention for both macrovascular and microvascular diseases, particularly among women.

Keyword

Cardiovascular diseases; Diabetes mellitus, type 2; Diabetic nephropathies; Diabetic retinopathy; Prospective studies

Figure

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  Fig. 1. Dose-response relationship of 10-year atherosclerotic cardiovascular disease (ASCVD) risk with incident diabetic nephropathy (DN) and retinopathy (DR) in the (A) Guangzhou Diabetic Eye Study (GDES) and (B) Shaoguan Diabetic Eye Study (SDES) cohorts. The dose-response relationship was examined using restricted cubic splines with 3 knots, located at the 10th, 50th, and 90th percentiles of the distribution of 10-year ASCVD risk in the GDES and SDES cohorts, respectively. The solid line represents the fitted curve, and the shaded areas represent the 95% confidence interval (CI) bands. GDES cohort: P-overall <0.001 and P-nonlinearity=0.757 for DN; P-overall =0.974 and P-nonlinearity=0.865 for DR. SDES cohort: P-overall <0.001 and P-nonlinearity=0.907 for DN; P-overall=0.206 and P-nonlinearity=0.075 for DR. HR, hazard ratio.

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  Fig. 2. Hazard ratio (HR) (95% confidence interval [CI]) for (A) diabetic nephropathy (DN) and (B) retinopathy (DR) associated with per 1% increase in 10-year atherosclerotic cardiovascular disease (ASCVD) risk. Crude model refers to Cox proportional hazard model with no adjustment. Adjusted model refers to multivariable-adjusted Cox proportional hazard model in which education level, regular drinking, duration of diabetes, use of insulin, and glycosylated hemoglobin were included as covariates. Cohort-specific results were pooled using inverse variance-weighted, fixed-effect meta-analyses. GDES, Guangzhou Diabetic Eye Study; SDES, Shaoguan Diabetic Eye Study.

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  Fig. 3. Pooled hazard ratio (HR) (95% confidence interval [CI]) for diabetic nephropathy (DN) and retinopathy (DR) associated with per 1% increase in 10-year atherosclerotic cardiovascular disease risk across subgroups according to baseline characteristics. Models adjusted for education level, regular drinking, duration of diabetes, use of insulin, and glycosylated hemoglobin (HbA1c). Cohort-specific results were pooled using inverse variance-weighted, fixed-effect meta-analyses. BMI, body mass index; WC, waist circumference. aHeterogeneity between subgroups was assessed by Cochrane’s Q test.

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