title: Prognostic impact of aortic stiffness in high-risk type 2 diabetic patients: the Rio deJaneiro Type 2 Diabetes Cohort Study.
abstract: OBJECTIVE
  The prognostic importance of carotid-femoral pulse wave velocity (PWV), the gold standard measure of aortic stiffness, has been scarcely investigated in type 2 diabetes and never after full adjustment for potential confounders. The aim was to evaluate the prognostic impact of carotid-femoral PWV for cardiovascular morbidity and all-cause mortality in a cohort of 565 high-risk type 2 diabetic patients.
  
  
  METHODS
  Clinical, laboratory, ambulatory blood pressure (BP) monitoring, and carotid-femoral PWV data were obtained at baseline. The primary end points were a composite of fatal and nonfatal cardiovascular events and all-cause mortality. Multiple Cox survival analysis was used to assess the associations between carotid-femoral PWV, as a continuous variable and categorized at 10 m/s, and the end points.
  
  
  RESULTS
  After a median follow-up of 5.75 years, 88 total cardiovascular events and 72 all-cause deaths occurred. After adjustments for potential cardiovascular risk factors, including micro- and macrovascular complications, ambulatory BP, and metabolic control, carotid-femoral PWV was predictive of the composite end point but not of all-cause mortality both as a continuous variable (hazard ratio 1.13 [95% CI 1.03-1.23], P = 0.009 for increments of 1 m/s) and as categorized at 10 m/s (1.92 [1.16-3.18], P = 0.012). On sensitivity analysis, carotid-femoral PWV was a better predictor of cardiovascular events in younger patients (<65 years), in those with microvascular complications, and in those with poorer glycemic control (HbA1c ≥7.5% [58.5 mmol/mol]).
  
  
  CONCLUSIONS
  Carotid-femoral PWV provides cardiovascular risk prediction independent of standard risk factors, glycemic control, and ambulatory BPs and improves cardiovascular risk stratification in high-risk type 2 diabetes.
authors.affiliation: Corresponding author: Gil F. Salles, gilsalles@hucff.ufrj.br.
authors.forename: Claudia R L
authors.initials: CR
authors.lastname: Cardoso
authors.forename: Marcel T
authors.initials: MT
authors.lastname: Ferreira
authors.forename: Nathalie C
authors.initials: NC
authors.lastname: Leite
authors.forename: Gil F
authors.initials: GF
authors.lastname: Salles
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000503:physiopathology*; D018660:Blood Pressure Monitoring, Ambulatory; D001938:Brazil / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D063177:Pulse Wave Analysis; D012307:Risk Factors; D059289:Vascular Stiffness