title: Baseline predictors of aortic stiffness progression among multi-ethnic Asians with type 2 diabetes.
abstract: This 3-year prospective study aimed to identify baseline parameters that predicted the progression of carotid-femoral pulse wave velocity (cf-PWV), which was used to evaluate aortic stiffness, among Singapore's multi-ethnic Asians with type 2 diabetes (T2DM).
  
  
  
  The cf-PWV was measured by the gold-standard tonometry method in 994 T2DM subjects at baseline and follow-up. The annual rate of cf-PWV change was calculated, and individuals above the 90thpercentile with rate≥1.42 m/s per year were regarded as rapid progressors (n = 104). In a subgroup analysis of subjects with normal cf-PWV at 1stvisit (n = 611), incident aortic stiffness was defined as follow-up cf-PWV≥10 m/s (n = 188).
  
  
  
  The total cohort (mean age:57 ± 10 years; 53.4% Chinese, 20.4% Malay, 22.9% Indian, 3.2% 'Others') displayed a median annual cf-PWV progression rate of 0.2 m/s. Adjusted multivariate regression analyses showed that baseline age, cf-PWV and body mass index (BMI) constantly predicted follow-up cf-PWV, annual cf-PWV progression rate, rapid cf-PWV progression, and incident aortic stiffness. Paradoxically, lower baseline cf-PWV was associated with elevated annual cf-PWV progression rate and rapid progressors. This inverse relationship remained significant across ethnicities after ethnic stratification. Higher BMI independently predicted cf-PWV progression in Chinese and Indians, but not in Malay and 'Others' ethnic groups. Increased age was a significant predictor in Chinese and 'Others' ethnicities.
  
  
  
  We demonstrated that baseline BMI is a modifiable independent risk factor of cf-PWV progression and incident aortic stiffness. Therefore, better obesity management may impede aortic stiffness in Singapore's T2DM patients, especially in the Chinese and Indians.
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore.
authors.forename: Mei Chung
authors.initials: MC
authors.lastname: Moh
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore.
authors.forename: Chee Fang
authors.initials: CF
authors.lastname: Sum
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore.
authors.forename: Subramaniam
authors.initials: S
authors.lastname: Tavintharan
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore.
authors.forename: Keven
authors.initials: K
authors.lastname: Ang
authors.affiliation: National Healthcare Group Polyclinics, 3 Fusionopolis Link, Nexus@one-north, South Tower, # 05-10, Singapore 138543, Singapore.
authors.forename: Simon Biing Ming
authors.initials: SBM
authors.lastname: Lee
authors.affiliation: National Healthcare Group Polyclinics, 3 Fusionopolis Link, Nexus@one-north, South Tower, # 05-10, Singapore 138543, Singapore.
authors.forename: Wern Ee
authors.initials: WE
authors.lastname: Tang
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore. Electronic address: lim.su.chi@alexandrahealth.com.sg.
authors.forename: Su Chi
authors.initials: SC
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D002339:Carotid Arteries / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000208:ethnology; D003925:Diabetic Angiopathies / Q000208:ethnology* / Q000209:etiology / Q000503:physiopathology; D018450:Disease Progression; D005006:Ethnicity; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry / Q000295:instrumentation; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D013997:Time Factors; D059289:Vascular Stiffness / Q000502:physiology*; D055815:Young Adult
keywords: Aortic stiffness progression; Body mass index; Carotid-femoral pulse wave velocity; Multi-ethnic Asians; Type 2 diabetes