Assessment of cardiovascular complications in patients with type 2 diabetes

Assessment of cardiovascular complications in patients with type 2 diabetes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of cardiovascular complications in patients with type 2 diabetes Sally Bshara, Qamar Alkhoubi, Taghreed Hamood This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4284274/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Type 2 diabetes mellitus (T2DM) has become a global health crisis characterized by chronic elevation of blood sugar levels (hyperglycaemia) and a range of metabolic disorders. One of the most significant complications of type 2 diabetes is a greatly increased risk of cardiovascular complications (CVD). These complications include coronary artery disease (CAD), peripheral arterial disease, and heart failure, which are the leading cause of death. Due to the substantial burden on healthcare associated with cardiovascular diseases in type 2 diabetes, accurate and comprehensive assessment of cardiovascular risk factors is of paramount importance. This chapter will highlight cardiovascular complications in these patients, discussing risk factors, assessment mechanisms, and the importance of integrating medical history, physical examination, and appropriate diagnostic tools. Through critical evaluation of these assessment strategies, we aim to equip healthcare providers with the necessary knowledge to effectively identify and manage cardiovascular risks in high-risk patients. Methods : A retrospective cross-sectional study was conducted utilizing patient records and data. Inclusion criteria comprised patients diagnosed with T2DM with high risk of cardiovascular risk. Ethical approval was obtained from the institutional review board or ethics committee, ensuring patient confidentiality and data anonymization. Informed consent was not required due to the retrospective nature of the study. Statistical analysis was performed using SPSS version 26.0, computing descriptive statistics including frequencies, percentages, means, and standard deviations. Results : Among 101 diabetic cases, the average age of patients was 41 years with a standard deviation of 24, and more than half of the sample were females. Approximately one-fifth of the patients were smokers. The predominant type was type 2 diabetes, and most patients were in a state of ketoacidosis at diagnosis. Medical histories were present in more than one-third of the patients, while surgical histories were present in almost half. More than one-fifth of the patients suffered from systemic complications of diabetes. The prevalence of cardiovascular complications among patients was 30%, with hypertension being the most common among them. Most type 2 diabetic patients were uncontrolled. Conclusion: To reduce the risk of cardiovascular diseases in diabetic patients, assisting patients in adopting a healthy lifestyle by promoting physical activity, weight reduction, and cessation of alcohol consumption during follow-up is a crucial step. Additionally, we recommend a multifactorial intervention aimed at achieving recommended levels of critical indicators (blood pressure, blood cholesterol, microvascular complications, and early-stage treatment). cardiovascular complications type 2 diabetes risk factors Introduction Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by insulin resistance and relative insulin deficiency, resulting in hyperglycemia. It is a significant global health concern, with an estimated 463 million adults affected worldwide in 2019, a number projected to rise to 700 million by 2045 ( 1 ). Apart from its direct effects on glucose metabolism, T2DM is associated with a multitude of complications affecting various organ systems, particularly the cardiovascular system. Cardiovascular complications are a leading cause of morbidity and mortality in patients with T2DM, significantly reducing life expectancy and quality of life ( 2 ). Patients with T2DM have a markedly increased risk of developing cardiovascular diseases (CVD), including coronary artery disease, stroke, and peripheral arterial disease, compared to individuals without diabetes ( 3 ). This elevated risk persists even after accounting for traditional cardiovascular risk factors such as hypertension, dyslipidemia, and smoking ( 4 ). Moreover, the presence of diabetes complicates the management and prognosis of cardiovascular conditions, necessitating tailored approaches to risk assessment, prevention, and treatment ( 5 ). Assessing cardiovascular complications in patients with T2DM is paramount for early detection, risk stratification, and targeted interventions aimed at mitigating adverse outcomes. Various clinical and laboratory markers are utilized in this assessment, ranging from traditional risk factors like blood pressure and lipid profile to novel biomarkers such as high-sensitivity C-reactive protein (hs-CRP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and cardiac imaging modalities like echocardiography and coronary computed tomography angiography (CTA) ( 6 , 7 ). This paper aims to provide a comprehensive review of the assessment of cardiovascular complications in patients with T2DM, focusing on the epidemiology, pathophysiology, clinical manifestations, diagnostic approaches, and management strategies. By synthesizing existing evidence and highlighting recent advancements in the field, we seek to enhance understanding and promote effective management of cardiovascular complications in this high-risk population. Methods Study design and participants: A retrospective study was conducted among a sample of patients from the outpatient clinic at Damascus Hospital - Al-Mujtahed who were accepted into either the endocrinology or cardiology department, totaling 101 patients. Ethical approval was obtained from the Ethics Committee to access patients' records while maintaining all their information and using it within the study context. Inclusion criteria included patients accepted with a cardiovascular diagnosis based on type 2 diabetes mellitus. Exclusion criteria involved patients who were not diagnosed with diabetes despite having cardiovascular injury. Data from 101 patients were collected using a questionnaire, with ethical approval obtained from the Institutional Review Board (IRB) of the Faculty of Medicine, Syrian Private University. Questioner: The questionnaire was designed to include the following questions: age, gender, smoking status (number of packs per year), type of diabetes, diagnosis upon hospital admission, medication history, medical history, surgical history, family history, systemic complications of diabetes, cardiovascular complications, glucose levels, blood pressure, fasting glucose, random glucose, creatinine, heart rate (HR), potassium, calcium, sodium, triglycerides, creatine kinase (CK), peripheral oxygen saturation (sPO2), C-reactive protein (CRP), initial glucose measurement upon admission, and whether diabetes is pharmacologically controlled or not. Statistical Analysis: The study was conducted using SPSS version 25. Descriptive analysis was performed, including calculating the mean and standard deviation. Chi-Square test to examine whether there was a relationship between two categorical variables, using the Chi-Square statistic. Additionally, the One-way ANOVA test was used to test for differences between means. Results Among the 101 diabetic cases, the average age of the patients was 41 years with a standard deviation of 24, and more than half of the sample were females. Approximately one-fifth of the patients were smokers. The predominant type of diabetes was type 2, and most patients were in a state of ketoacidosis at diagnosis. Medical histories were present in more than one-third of the patients, while surgical histories were present in almost half of them. More than one-fifth of the patients suffered from one of the systemic complications of diabetes. The prevalence of cardiovascular complications among the patients was 30%, with hypertension being the most common among them. Most type 2 diabetic patients were not pharmacologically controlled. When studying the relationship between patient characteristics and the occurrence of cardiovascular complications, the results revealed statistically significant relationships as follows: Smoking showed a statistically significant relationship (P < 0.05), with most smokers experiencing cardiovascular complications. Similarly, the analysis showed a statistically significant association with the type of diabetes, with 36.7% of type 2 diabetic patients having at least one cardiovascular complication, while most type 1 diabetic patients were not diagnosed with any. Additionally, the occurrence of cardiovascular complications was associated with the diagnosis upon admission, where 27.4% of patients diagnosed with DKA upon admission had cardiovascular complications, and all patients diagnosed with renal impairment had a statistically significant association. Cardiovascular complications were more common among patients with medical histories, with a significant association. The average age was associated with both the occurrence of cardiovascular complications and hypertension, favoring patients with an average age of 60 years, with a statistically significant association. Finally, the average glucose measurement upon admission was associated with both the occurrence of cardiovascular complications and hypertension, favoring patients with an average measurement of over 190 mg/dl, with a statistically significant association. No statistically significant relationship was found between the occurrence of cardiovascular complications and the rest of the laboratory findings. When studying the relationship between patient characteristics and the occurrence of systemic complications, the results revealed statistically significant relationships as follows: Smoking showed a statistically significant relationship (P < 0.05), with most smokers experiencing systemic complications. Similarly, the analysis showed a statistically significant association with the type of diabetes, with 29.1% of type 2 diabetic patients having at least one systemic complication, while most type 1 diabetic patients were not diagnosed with any. Additionally, the occurrence of systemic complications was associated with the diagnosis upon admission, where 22.1% of patients diagnosed with DKA upon admission had systemic complications, and all patients diagnosed with renal impairment had a statistically significant association. Discussion Identifying modifiable risk factors associated with cardiovascular diseases is a crucial initial step in preventing and combating them among diabetic patients. In this study, the overall prevalence rate of cardiovascular diseases was 30.7%. Specific complications accounted for 22.8% for hypertension-related heart diseases, approximately 6% for heart failure, and 2% for other cardiac disorders. The rate in this study aligns with the results reported in a systematic review of studies published from 2007 to 2017 (32%), even in terms of the prevalence rates of hypertension ( 8 ). However, the overall prevalence rate was higher compared to studies conducted in Iraq ( 9 ) and Scotland ( 10 ). Yet, the prevalence of hypertension was lower than the study reported in Iraq, which was 44.3% ( 9 ). This discrepancy may be due to differences in sample size, follow-up, and treatment protocols between countries. Differences in subtypes of cardiovascular diseases have also been observed in other studies ( 10 , 11 ). Hypertension is common among both type 1 and type 2 diabetic patients, with prevalence rates of 30% and 60%, respectively ( 12 ). In this study, 27.8% of type 2 diabetic patients had hypertension, compared to 4.5% of type 1 patients. Hypertension among diabetic patients is closely associated with the development of diabetic nephropathy. Renal impairment was present as an initial diagnosis in 3% of patients and as a late complication in approximately 11%. With the progression of renal impairment, renal cells are stimulated by elevated blood glucose levels, leading to the production of cytokines and growth factors. These factors are often responsible for the structural changes observed in diabetic kidneys, including hyaline arteriosclerosis (primarily in efferent arterioles), increased collagen deposition in the extracellular matrix, and increased permeability of the glomerular basement membrane. These structural changes increase glomerular filtration pressure and often lead to increased microalbuminuria with compensatory activation of the renin-angiotensin-aldosterone system (RAAS). Chronic activation of RAAS often leads to hypertension, increasing pressure on the glomeruli and causing additional damage to nephrons in diabetic patients. Left untreated, renal impairment can progress to a nephrotic syndrome characterized by proteinuria, hypercoagulability, and hyperlipidemia, which may contribute to an increased risk of cardiovascular diseases in diabetic patients with renal dysfunction. An average age of 60 years was closely and statistically significantly associated with both cardiovascular complications and hypertension. This finding is comparable to results from studies conducted in Pakistan ( 13 ), Taiwan ( 14 ), and Sweden ( 15 ), all of which revealed that advancing age is an important indicator of cardiovascular events among diabetic patients. Aging can cause changes in the heart and blood vessels, increasing the risk of cardiovascular diseases. Additionally, there is an increase in the prevalence of arteriosclerosis due to the progression of diabetes in advanced age ( 16 ). A clear association was observed between smoking and both cardiovascular and systemic complications among diabetic patients in this study. Most previous studies have indicated that smoking habit is a risk factor for cardiovascular diseases, as it alters the blood glucose control process ( 17 , 18 ). In the INTERHEART study conducted in 52 countries, smoking was among the modifiable risk factors for cardiovascular diseases ( 19 ). Study's limitations: This is a retrospective study, thus recall bias is common. In addition, unable to determine casualty. Furthermore, subjective assessments may not be as accurate as objective. Conclusion To reduce the risk of cardiovascular diseases among diabetic patients, assisting patients in achieving a healthy lifestyle is a fundamental step. This can be achieved by encouraging physical activity, weight reduction, and cessation of alcohol consumption during follow-up. Additionally, we recommend a multifactorial intervention aimed at achieving recommended levels of critical indicators (blood pressure, blood cholesterol, microvascular complications) and early-stage treatment. Declarations Ethical approval: Ethical approval was obtained from the Institutional Review Board (IRB), Faculty of Medicine, Syrian Private University. Funding statement: No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this article. Availability of supporting data: The data that support the findings of this study are available from the Corresponding author, upon reasonable request. Competing interests: The authors declare that they have no competing interests. Acknowledgments: Not applicable. References International Diabetes Federation. IDF Diabetes Atlas, 9th edn. Brussels, Belgium: 2019. American Diabetes Association. "Cardiovascular Disease and Risk Management." Diabetes Care 40.Supplement 1 (2017): S75-S87. Emerging Risk Factors Collaboration, Sarwar, N., Gao, P., et al. "Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies." The Lancet 375.9733 (2010): 2215-2222. Fox, Caroline S., et al. "Prevalence of cardiovascular complications in diabetes mellitus." Diabetes Care 29.8 (2006): 1891-1896. Jellinger, Paul S., et al. "American Association of Clinical Endocrinologists' Guidelines for Management of Dyslipidemia and Prevention of Atherosclerosis." Endocrine Practice 18.Supplement 1 (2012): 1-78. American Diabetes Association. "Standards of Medical Care in Diabetes-2021." Diabetes Care 44.Supplement 1 (2021): S1-S232. Cosentino, Francesco, et al. "2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD." European Heart Journal 41.2 (2020): 255-323. Einarson TR, Acs A, Ludwig C, Panton UH. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017. Cardiovasc Diabetol. (2018) 17:83. doi: 10.1186/s12933-018-0728-6 Mansour AA, Ajeel NA. Atherosclerotic cardiovascular disease among patients with type 2 diabetes in Basrah. World J Diabetes. 2013 Jun 15;4(3):82-7. doi: 10.4239/wjd.v4.i3.82. PMID: 23772277; PMCID: PMC3680628. Malik MO, Govan L, Petrie JR, Ghouri N, Leese G, Fischbacher C, Colhoun H, Philip S, Wild S, McCrimmon R, Sattar N, Lindsay RS; Scottish Diabetes Research Network Epidemiology Group. Ethnicity and risk of cardiovascular disease (CVD): 4.8 year follow-up of patients with type 2 diabetes living in Scotland. Diabetologia. 2015 Apr;58(4):716-25. doi: 10.1007/s00125-015-3492-0. Epub 2015 Feb 12. PMID: 25669630. Matheus AS, Tannus LR, Cobas RA, Palma CC, Negrato CA, Gomes MB. Impact of diabetes on cardiovascular disease: an update. Int J Hypertens. 2013;2013:653789. Schena FP, Gesualdo L. Pathogenetic mechanisms of diabetic nephropathy. J Am Soc Nephrol. 2005;16 Suppl 1:S30–S33. Gesualdo L, Ranieri E, Monno R, Rossiello MR, Colucci M, Semeraro N, Grandaliano G, Schena FP, Ursi M, Cerullo G. Angiotensin IV stimulates plasminogen activator inhibitor-1 expression in proximal tubular epithelial cells. Kidney Int. 1999;56:461–470. Wolf G, Ziyadeh FN. The role of angiotensin II in diabetic nephropathy: emphasis on nonhemodynamic mechanisms. Am J Kidney Dis. 1997;29:153–163. Kornelius E, Chiou J-Y, Yang Y-S, Lu Y-L, Peng C-H, Huang C-N. The diabetes shared care program and risks of cardiovascular events in type 2 diabetes. Am J Med. (2015) 128:977–85. doi: 10.1016/j.amjmed.2015.03.025 Rawshani A, Rawshani A, Franzén S, Sattar N, Eliasson B, Svensson A-M, et al. Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. (2018) 379:633–44. doi: 10.1056/NEJMoa1800256 Zhou K, Donnelly LA, Morris AD, Franks PW, Jennison C, Palmer CN, et al. Clinical and genetic determinants of progression of type 2 diabetes: a direct study. Diabetes Care. (2014) 37:718–24. doi: 10.2337/dc13-1995 Ballotari P, Venturelli F, Greci M, Giorgi Rossi P, Manicardi V. Sex differences in the effect of type 2 diabetes on major cardiovascular diseases: results from a population-based study in Italy. Int J Endocrinol. (2017) 2017: 6039356. doi: 10.1155/2017/6039356 Balakumar P, Maung-U K, Jagadeesh G. Prevalence and prevention of cardiovascular disease and diabetes mellitus. Pharmacol Res. (2016) 113:600–9. doi: 10.1016/j.phrs.2016.09.040 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4284274","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":292531546,"identity":"42827a2e-037b-4501-98ff-fb4b3bf8f130","order_by":0,"name":"Sally Bshara","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIiWNgGAWjYFAC5sYDjA0MCSDmgQQDGyDF2HgAvxbGBpgWxgMPCtIgIsRqYT744MNhsBheLfLtBxsO8+6oy+OfffgB0GHn7da2HwbaUmMTjUuLwZlEoJYzh4slzqUZALXcTt4GFDnAcCwttwGXFgaQlrYDiQ1nGCBazIBsoFMP49Qi3/8QpKUucf4Z9g9ALeeSzc4/xK+F4QbYFubEDWd4QLYcsDO7QcAWgxsPGw7OPXM4ceMZngKgluQEM6DIgQQ8fpHvTz744O2OusR5Z9g3f/zxx87e7Hz6wwcfamxwOwwImHiQOIlglQl4lIMA4w8kjj0BxaNgFIyCUTACAQBYW3XsANp6ZQAAAABJRU5ErkJggg==","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Sally","middleName":"","lastName":"Bshara","suffix":""},{"id":292531547,"identity":"d334b782-d47a-46c9-ba9b-305fbcafd44d","order_by":1,"name":"Qamar Alkhoubi","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Qamar","middleName":"","lastName":"Alkhoubi","suffix":""},{"id":292531548,"identity":"b0c06887-3d8d-403f-a45b-e9db73f58bb2","order_by":2,"name":"Taghreed Hamood","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Taghreed","middleName":"","lastName":"Hamood","suffix":""}],"badges":[],"createdAt":"2024-04-18 00:06:14","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4284274/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4284274/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54948232,"identity":"07d460db-cbd5-43a7-bdbc-5e0810d2e5fd","added_by":"auto","created_at":"2024-04-19 04:10:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":201073,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4284274/v1/8e2a4a9f-4fa5-4560-800c-9742b02d2436.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eAssessment of cardiovascular complications in patients with type 2 diabetes\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eType 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by insulin resistance and relative insulin deficiency, resulting in hyperglycemia. It is a significant global health concern, with an estimated 463\u0026nbsp;million adults affected worldwide in 2019, a number projected to rise to 700\u0026nbsp;million by 2045 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Apart from its direct effects on glucose metabolism, T2DM is associated with a multitude of complications affecting various organ systems, particularly the cardiovascular system. Cardiovascular complications are a leading cause of morbidity and mortality in patients with T2DM, significantly reducing life expectancy and quality of life (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePatients with T2DM have a markedly increased risk of developing cardiovascular diseases (CVD), including coronary artery disease, stroke, and peripheral arterial disease, compared to individuals without diabetes (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). This elevated risk persists even after accounting for traditional cardiovascular risk factors such as hypertension, dyslipidemia, and smoking (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Moreover, the presence of diabetes complicates the management and prognosis of cardiovascular conditions, necessitating tailored approaches to risk assessment, prevention, and treatment (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAssessing cardiovascular complications in patients with T2DM is paramount for early detection, risk stratification, and targeted interventions aimed at mitigating adverse outcomes. Various clinical and laboratory markers are utilized in this assessment, ranging from traditional risk factors like blood pressure and lipid profile to novel biomarkers such as high-sensitivity C-reactive protein (hs-CRP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and cardiac imaging modalities like echocardiography and coronary computed tomography angiography (CTA) (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis paper aims to provide a comprehensive review of the assessment of cardiovascular complications in patients with T2DM, focusing on the epidemiology, pathophysiology, clinical manifestations, diagnostic approaches, and management strategies. By synthesizing existing evidence and highlighting recent advancements in the field, we seek to enhance understanding and promote effective management of cardiovascular complications in this high-risk population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and participants:\u003c/h2\u003e \u003cp\u003eA retrospective study was conducted among a sample of patients from the outpatient clinic at Damascus Hospital - Al-Mujtahed who were accepted into either the endocrinology or cardiology department, totaling 101 patients. Ethical approval was obtained from the Ethics Committee to access patients' records while maintaining all their information and using it within the study context. Inclusion criteria included patients accepted with a cardiovascular diagnosis based on type 2 diabetes mellitus. Exclusion criteria involved patients who were not diagnosed with diabetes despite having cardiovascular injury. Data from 101 patients were collected using a questionnaire, with ethical approval obtained from the Institutional Review Board (IRB) of the Faculty of Medicine, Syrian Private University.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eQuestioner:\u003c/h2\u003e \u003cp\u003eThe questionnaire was designed to include the following questions: age, gender, smoking status (number of packs per year), type of diabetes, diagnosis upon hospital admission, medication history, medical history, surgical history, family history, systemic complications of diabetes, cardiovascular complications, glucose levels, blood pressure, fasting glucose, random glucose, creatinine, heart rate (HR), potassium, calcium, sodium, triglycerides, creatine kinase (CK), peripheral oxygen saturation (sPO2), C-reactive protein (CRP), initial glucose measurement upon admission, and whether diabetes is pharmacologically controlled or not.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis:\u003c/h2\u003e \u003cp\u003eThe study was conducted using SPSS version 25. Descriptive analysis was performed, including calculating the mean and standard deviation. Chi-Square test to examine whether there was a relationship between two categorical variables, using the Chi-Square statistic. Additionally, the One-way ANOVA test was used to test for differences between means.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAmong the 101 diabetic cases, the average age of the patients was 41 years with a standard deviation of 24, and more than half of the sample were females. Approximately one-fifth of the patients were smokers. The predominant type of diabetes was type 2, and most patients were in a state of ketoacidosis at diagnosis. Medical histories were present in more than one-third of the patients, while surgical histories were present in almost half of them. More than one-fifth of the patients suffered from one of the systemic complications of diabetes. The prevalence of cardiovascular complications among the patients was 30%, with hypertension being the most common among them. Most type 2 diabetic patients were not pharmacologically controlled. When studying the relationship between patient characteristics and the occurrence of cardiovascular complications, the results revealed statistically significant relationships as follows: Smoking showed a statistically significant relationship (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with most smokers experiencing cardiovascular complications. Similarly, the analysis showed a statistically significant association with the type of diabetes, with 36.7% of type 2 diabetic patients having at least one cardiovascular complication, while most type 1 diabetic patients were not diagnosed with any. Additionally, the occurrence of cardiovascular complications was associated with the diagnosis upon admission, where 27.4% of patients diagnosed with DKA upon admission had cardiovascular complications, and all patients diagnosed with renal impairment had a statistically significant association. Cardiovascular complications were more common among patients with medical histories, with a significant association.\u003c/p\u003e \u003cp\u003eThe average age was associated with both the occurrence of cardiovascular complications and hypertension, favoring patients with an average age of 60 years, with a statistically significant association. Finally, the average glucose measurement upon admission was associated with both the occurrence of cardiovascular complications and hypertension, favoring patients with an average measurement of over 190 mg/dl, with a statistically significant association. No statistically significant relationship was found between the occurrence of cardiovascular complications and the rest of the laboratory findings.\u003c/p\u003e \u003cp\u003eWhen studying the relationship between patient characteristics and the occurrence of systemic complications, the results revealed statistically significant relationships as follows: Smoking showed a statistically significant relationship (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with most smokers experiencing systemic complications. Similarly, the analysis showed a statistically significant association with the type of diabetes, with 29.1% of type 2 diabetic patients having at least one systemic complication, while most type 1 diabetic patients were not diagnosed with any. Additionally, the occurrence of systemic complications was associated with the diagnosis upon admission, where 22.1% of patients diagnosed with DKA upon admission had systemic complications, and all patients diagnosed with renal impairment had a statistically significant association.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIdentifying modifiable risk factors associated with cardiovascular diseases is a crucial initial step in preventing and combating them among diabetic patients. In this study, the overall prevalence rate of cardiovascular diseases was 30.7%. Specific complications accounted for 22.8% for hypertension-related heart diseases, approximately 6% for heart failure, and 2% for other cardiac disorders. The rate in this study aligns with the results reported in a systematic review of studies published from 2007 to 2017 (32%), even in terms of the prevalence rates of hypertension (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). However, the overall prevalence rate was higher compared to studies conducted in Iraq (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) and Scotland (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Yet, the prevalence of hypertension was lower than the study reported in Iraq, which was 44.3% (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). This discrepancy may be due to differences in sample size, follow-up, and treatment protocols between countries. Differences in subtypes of cardiovascular diseases have also been observed in other studies (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHypertension is common among both type 1 and type 2 diabetic patients, with prevalence rates of 30% and 60%, respectively (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In this study, 27.8% of type 2 diabetic patients had hypertension, compared to 4.5% of type 1 patients. Hypertension among diabetic patients is closely associated with the development of diabetic nephropathy.\u003c/p\u003e \u003cp\u003eRenal impairment was present as an initial diagnosis in 3% of patients and as a late complication in approximately 11%. With the progression of renal impairment, renal cells are stimulated by elevated blood glucose levels, leading to the production of cytokines and growth factors. These factors are often responsible for the structural changes observed in diabetic kidneys, including hyaline arteriosclerosis (primarily in efferent arterioles), increased collagen deposition in the extracellular matrix, and increased permeability of the glomerular basement membrane. These structural changes increase glomerular filtration pressure and often lead to increased microalbuminuria with compensatory activation of the renin-angiotensin-aldosterone system (RAAS). Chronic activation of RAAS often leads to hypertension, increasing pressure on the glomeruli and causing additional damage to nephrons in diabetic patients. Left untreated, renal impairment can progress to a nephrotic syndrome characterized by proteinuria, hypercoagulability, and hyperlipidemia, which may contribute to an increased risk of cardiovascular diseases in diabetic patients with renal dysfunction.\u003c/p\u003e \u003cp\u003eAn average age of 60 years was closely and statistically significantly associated with both cardiovascular complications and hypertension. This finding is comparable to results from studies conducted in Pakistan (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), Taiwan (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), and Sweden (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), all of which revealed that advancing age is an important indicator of cardiovascular events among diabetic patients. Aging can cause changes in the heart and blood vessels, increasing the risk of cardiovascular diseases. Additionally, there is an increase in the prevalence of arteriosclerosis due to the progression of diabetes in advanced age (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA clear association was observed between smoking and both cardiovascular and systemic complications among diabetic patients in this study. Most previous studies have indicated that smoking habit is a risk factor for cardiovascular diseases, as it alters the blood glucose control process (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). In the INTERHEART study conducted in 52 countries, smoking was among the modifiable risk factors for cardiovascular diseases (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStudy's limitations:\u003c/h2\u003e \u003cp\u003eThis is a retrospective study, thus recall bias is common. In addition, unable to determine casualty. Furthermore, subjective assessments may not be as accurate as objective.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTo reduce the risk of cardiovascular diseases among diabetic patients, assisting patients in achieving a healthy lifestyle is a fundamental step. This can be achieved by encouraging physical activity, weight reduction, and cessation of alcohol consumption during follow-up. Additionally, we recommend a multifactorial intervention aimed at achieving recommended levels of critical indicators (blood pressure, blood cholesterol, microvascular complications) and early-stage treatment.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Institutional Review Board (IRB), Faculty of Medicine, Syrian Private University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of supporting data:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the Corresponding author, upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eInternational Diabetes Federation. IDF Diabetes Atlas, 9th edn. Brussels, Belgium: 2019.\u003c/li\u003e\n \u003cli\u003eAmerican Diabetes Association. \u0026quot;Cardiovascular Disease and Risk Management.\u0026quot; Diabetes Care 40.Supplement 1 (2017): S75-S87.\u003c/li\u003e\n \u003cli\u003eEmerging Risk Factors Collaboration, Sarwar, N., Gao, P., et al. \u0026quot;Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies.\u0026quot; The Lancet 375.9733 (2010): 2215-2222.\u003c/li\u003e\n \u003cli\u003eFox, Caroline S., et al. \u0026quot;Prevalence of cardiovascular complications in diabetes mellitus.\u0026quot; Diabetes Care 29.8 (2006): 1891-1896.\u003c/li\u003e\n \u003cli\u003eJellinger, Paul S., et al. \u0026quot;American Association of Clinical Endocrinologists\u0026apos; Guidelines for Management of Dyslipidemia and Prevention of Atherosclerosis.\u0026quot; Endocrine Practice 18.Supplement 1 (2012): 1-78.\u003c/li\u003e\n \u003cli\u003eAmerican Diabetes Association. \u0026quot;Standards of Medical Care in Diabetes-2021.\u0026quot; Diabetes Care 44.Supplement 1 (2021): S1-S232.\u003c/li\u003e\n \u003cli\u003eCosentino, Francesco, et al. \u0026quot;2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD.\u0026quot; European Heart Journal 41.2 (2020): 255-323.\u003c/li\u003e\n \u003cli\u003eEinarson TR, Acs A, Ludwig C, Panton UH. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007\u0026ndash;2017. Cardiovasc Diabetol. (2018) 17:83. doi: 10.1186/s12933-018-0728-6\u003c/li\u003e\n \u003cli\u003eMansour AA, Ajeel NA. Atherosclerotic cardiovascular disease among patients with type 2 diabetes in Basrah. World J Diabetes. 2013 Jun 15;4(3):82-7. doi: 10.4239/wjd.v4.i3.82. PMID: 23772277; PMCID: PMC3680628.\u003c/li\u003e\n \u003cli\u003eMalik MO, Govan L, Petrie JR, Ghouri N, Leese G, Fischbacher C, Colhoun H, Philip S, Wild S, McCrimmon R, Sattar N, Lindsay RS; Scottish Diabetes Research Network Epidemiology Group. Ethnicity and risk of cardiovascular disease (CVD): 4.8 year follow-up of patients with type 2 diabetes living in Scotland. Diabetologia. 2015 Apr;58(4):716-25. doi: 10.1007/s00125-015-3492-0. Epub 2015 Feb 12. PMID: 25669630.\u003c/li\u003e\n \u003cli\u003eMatheus AS, Tannus LR, Cobas RA, Palma CC, Negrato CA, Gomes MB. Impact of diabetes on cardiovascular disease: an update. Int J Hypertens. 2013;2013:653789.\u003c/li\u003e\n \u003cli\u003eSchena FP, Gesualdo L. Pathogenetic mechanisms of diabetic nephropathy. J Am Soc Nephrol. 2005;16 Suppl 1:S30\u0026ndash;S33.\u003c/li\u003e\n \u003cli\u003eGesualdo L, Ranieri E, Monno R, Rossiello MR, Colucci M, Semeraro N, Grandaliano G, Schena FP, Ursi M, Cerullo G. Angiotensin IV stimulates plasminogen activator inhibitor-1 expression in proximal tubular epithelial cells. Kidney Int. 1999;56:461\u0026ndash;470.\u003c/li\u003e\n \u003cli\u003eWolf G, Ziyadeh FN. The role of angiotensin II in diabetic nephropathy: emphasis on nonhemodynamic mechanisms. Am J Kidney Dis. 1997;29:153\u0026ndash;163. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKornelius E, Chiou J-Y, Yang Y-S, Lu Y-L, Peng C-H, Huang C-N. The diabetes shared care program and risks of cardiovascular events in type 2 diabetes. Am J Med. (2015) 128:977\u0026ndash;85. doi: 10.1016/j.amjmed.2015.03.025\u003c/li\u003e\n \u003cli\u003eRawshani A, Rawshani A, Franz\u0026eacute;n S, Sattar N, Eliasson B, Svensson A-M, et al. Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. (2018) 379:633\u0026ndash;44. doi: 10.1056/NEJMoa1800256\u003c/li\u003e\n \u003cli\u003eZhou K, Donnelly LA, Morris AD, Franks PW, Jennison C, Palmer CN, et al. Clinical and genetic determinants of progression of type 2 diabetes: a direct study. Diabetes Care. (2014) 37:718\u0026ndash;24. doi: 10.2337/dc13-1995\u003c/li\u003e\n \u003cli\u003eBallotari P, Venturelli F, Greci M, Giorgi Rossi P, Manicardi V. Sex differences in the effect of type 2 diabetes on major cardiovascular diseases: results from a population-based study in Italy. Int J Endocrinol. (2017) 2017: 6039356. doi: 10.1155/2017/6039356\u003c/li\u003e\n \u003cli\u003eBalakumar P, Maung-U K, Jagadeesh G. Prevalence and prevention of cardiovascular disease and diabetes mellitus. Pharmacol Res. (2016) 113:600\u0026ndash;9. doi: 10.1016/j.phrs.2016.09.040\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"cardiovascular complications, type 2 diabetes, risk factors","lastPublishedDoi":"10.21203/rs.3.rs-4284274/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4284274/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eType 2 diabetes mellitus (T2DM) has become a global health crisis characterized by chronic elevation of blood sugar levels (hyperglycaemia) and a range of metabolic disorders. One of the most significant complications of type 2 diabetes is a greatly increased risk of cardiovascular complications (CVD). These complications include coronary artery disease (CAD), peripheral arterial disease, and heart failure, which are the leading cause of death.\u003c/p\u003e\n\u003cp\u003eDue to the substantial burden on healthcare associated with cardiovascular diseases in type 2 diabetes, accurate and comprehensive assessment of cardiovascular risk factors is of paramount importance. This chapter will highlight cardiovascular complications in these patients, discussing risk factors, assessment mechanisms, and the importance of integrating medical history, physical examination, and appropriate diagnostic tools. Through critical evaluation of these assessment strategies, we aim to equip healthcare providers with the necessary knowledge to effectively identify and manage cardiovascular risks in high-risk patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A retrospective cross-sectional study was conducted utilizing patient records and data. Inclusion criteria comprised patients diagnosed with T2DM with high risk of cardiovascular risk. Ethical approval was obtained from the institutional review board or ethics committee, ensuring patient confidentiality and data anonymization. Informed consent was not required due to the retrospective nature of the study. Statistical analysis was performed using SPSS version 26.0, computing descriptive statistics including frequencies, percentages, means, and standard deviations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Among 101 diabetic cases, the average age of patients was 41 years with a standard deviation of 24, and more than half of the sample were females. Approximately one-fifth of the patients were smokers. The predominant type was type 2 diabetes, and most patients were in a state of ketoacidosis at diagnosis. Medical histories were present in more than one-third of the patients, while surgical histories were present in almost half. More than one-fifth of the patients suffered from systemic complications of diabetes. The prevalence of cardiovascular complications among patients was 30%, with hypertension being the most common among them. Most type 2 diabetic patients were uncontrolled.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eTo reduce the risk of cardiovascular diseases in diabetic patients, assisting patients in adopting a healthy lifestyle by promoting physical activity, weight reduction, and cessation of alcohol consumption during follow-up is a crucial step. Additionally, we recommend a multifactorial intervention aimed at achieving recommended levels of critical indicators (blood pressure, blood cholesterol, microvascular complications, and early-stage treatment).\u003c/p\u003e","manuscriptTitle":"Assessment of cardiovascular complications in patients with type 2 diabetes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-19 04:02:44","doi":"10.21203/rs.3.rs-4284274/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f5934cf1-8eea-451d-8cad-cb06003399f7","owner":[],"postedDate":"April 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-19T04:02:44+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-19 04:02:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4284274","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4284274","identity":"rs-4284274","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}