medwireNews: People with symptoms indicative of diabetic polyneuropathy (DPN) near the time of type 2 diabetes diagnosis have a “markedly higher” risk for subsequent cardiovascular disease (CVD) than those without, researchers report.
These findings are based on an analysis of two Danish type 2 diabetes cohorts, ADDITION-Denmark (n=1445) and DD2 (n=5028). A total of 13.1% of the ADDITION-Denmark cohort had symptoms indicative of DPN at the time of diagnosis, defined as a score of at least 4 points on the Michigan Neuropathy Screening Instrument questionnaire (MNSIq), while 16.2% of the DD2 cohort had such symptoms at a median of 4.6 years after diagnosis.
As reported in Diabetes Care, 27.3% of people in ADDITION-Denmark experienced a CVD event during a median 11.4 years of follow-up, as did 9.5% of those in DD2 over a median of 2.2 years.
“The main driver for the CVD end point was ischemic heart disease,” accounting for 58% and 51% of CVD events in ADDITION-Denmark and DD2, respectively, say Lasse Bjerg (Aarhus University, Denmark) and colleagues.
After adjustment for traditional CVD risk factors including age, sex, BMI, smoking, glycemic control, and prior CVD, people with DPN had a significant 79% higher CVD risk than those without in ADDITION-Denmark, and a significant 57% higher risk in DD2. When fixed-effect meta-analysis was used to combine data from both cohorts, DPN was associated with a significant 65% elevated CVD risk.
The team found that this association remained significant in a subgroup analysis restricted to people without CVD at baseline, and was “slightly stronger” than that seen in the main analysis, indicating that the findings were “not driven by second or subsequent CVD events.”
Conversely, there was no significant association between DPN and mortality risk.
Taken together, the study results suggest that “a diagnostic workup for symptoms of DPN using the MNSIq early in the course of type 2 diabetes may offer an opportunity to identify a subpopulation for whom intensive risk factor management could potentially reduce the [risk] of CVD,” write Bjerg et al.
They caution, however, that “we can only speculate that this information might add in predicting CVD over and above established risk scores,” and highlight the need for “[f]urther research […] to evaluate whether aggressive cardiovascular risk factor management in high-risk patients additionally identified by MNSIq score can successfully attenuate the excess CVD incidence.”
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