title: Body weight, metabolic dysfunction, and risk of type 2 diabetes in patients at high risk for cardiovascular events or with manifest cardiovascular disease: a cohort study.
abstract: OBJECTIVE
  To quantify the role of BMI and metabolic dysfunction in the risk of development of type 2 diabetes in patients at high risk or with manifest vascular disease.
  
  
  METHODS
  A total of 6,997 patients participating in the prospective Secondary Manifestations of ARTerial disease (SMART) cohort study were classified according to BMI and metabolic dysfunction, defined as three or more of the modified National Cholesterol Education Program (NCEP) metabolic syndrome criteria (waist circumference replaced by hs-CRP ≥2 mg/L). Risk of type 2 diabetes (assessed with biannually questionnaires) was estimated with Cox proportional hazards analysis.
  
  
  RESULTS
  During a median follow-up of 6.0 years (interquartile range 3.1-9.1 years), 519 patients developed type 2 diabetes (incidence rate 12/1,000 person-years). In the absence of metabolic dysfunction (≤2 NCEP criteria), adiposity increased the risk of type 2 diabetes compared with normal-weight patients (HR 2.5 [95% CI 1.5-4.2] for overweight and HR 4.3 [95% CI 2.2-8.6] for obese patients). In the presence of metabolic dysfunction (≥3 NCEP criteria), an increased risk of type 2 diabetes was observed in patients with normal weight (HR 4.7 [95% CI 2.8-7.8]), overweight (HR 8.5 [95% CI 5.5-13.4]), and obesity (HR 16.3 [95% CI 10.4-25.6]) compared with normal-weight patients without metabolic dysfunction.
  
  
  CONCLUSIONS
  Adiposity, even in the absence of metabolic dysfunction, is a risk factor for type 2 diabetes. Moreover, presence of metabolic dysfunction increases the risk of type 2 diabetes in all BMI categories. This supports the assessment of adiposity and metabolic dysfunction in patients with vascular disease or at high risk for cardiovascular events.
authors: Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: Bas T
authors: BT
authors: Franssens
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: Yolanda
authors: Y
authors: van der Graaf
authors: Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: L Jaap
authors: LJ
authors: Kappelle
authors: Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: Jan
authors: J
authors: Westerink
authors: Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: Gert J
authors: GJ
authors: de Borst
authors: Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: Maarten J
authors: MJ
authors: Cramer
authors: Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands f.l.j.visseren@umcutrecht.nl.
authors: Frank L J
authors: FL
authors: Visseren
mesh_terms: D050154:Adiposity / Q000502:physiology; D000368:Aged; D001835:Body Weight / Q000502:physiology*; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000209:etiology* / Q000503:physiopathology; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000503:physiopathology; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000503:physiopathology; D050177:Overweight / Q000150:complications / Q000503:physiopathology; D013997:Time Factors; D055105:Waist Circumference / Q000502:physiology