453-P: Metabolic Syndrome Severity Score, All-Cause Mortality, and Incident Vascular Events in Type 2 Diabetes: A 13-Year, Single-Centre, Follow-Up Study

Metabolic Syndrome (MetS) is associated with CV events in T2DM. We assessed over a 13-years follow-up the association between a “MetS severity score”, derived from WC, sBP, HDL and triglycerides (courtesy Dr. Mark DeBoer) and both all-cause death and incident CV events in 986 T2DM. Compared to lowest quartile, Q2-4 showed a steeply worsening CV risk profile. A total of 230 deaths occurred over 12.9±2.7 years (23.3%; 18.0 x 1000 PYs). Death rate was J-shaped: Q1 22.4%; Q2 18.2%; Q3 25.9% and Q4 26.8% (p=0.090). Electing arbitrarily Q2 as reference, and after adjustment for confounders and, finally, for parameters of MetS score, HRs (95% CI) vs. Q2 for death were: Q1 1.46 (0.97-2.19; p=0.070), Q3 1.61 (1.09-2.38; p=0.016) and Q4 1.82 (1.20-2.75, p=0.005). Over 11.3±4.4 years, 276 major CV events occurred in 972 T2DM (28.4%; 25.2 x 1000 PYs); adjusted HRs vs. Q1 were: Q2 1.34 (0.93-1.93; p=0.117), Q3 1.99 (1.40-2.82, p<0.0001) and Q4 2.37 (1.66-3.39, p<0.0001). Over 11.8±4.0 years, 184 coronary events occurred (18.9%; 16.03 x 1000 PYs); adjusted HRs vs. Q1 were: Q2 1.79 (1.12-2.84; p=0.015), Q3 2.27 (1.44-3.60, p<0.0001) and Q4 2.99 (1.88-4.74, p<0.0001). Over 12.7±3.1 years, 84 heart failure occurred (8.6%; 6.78 x 1000 PYs); HRs vs. Q1 were: Q2 2.23 (1.01-4.90; p=0.046), Q3 3.38 (1.56-7.31, p=0.002) and Q4 4.60 (2.16-9.82, p<0.0001). Finally, over 12.8±3.1 years, 71 ESRD occurred (7.3%; 5.72 x 1000 PYs); HRs vs. Q1 were: Q2 1.27 (0.57-2.82; p=0.558), Q3 2.12 (1.01-4.45, p=0.048) and Q4 2.16 (1.01-4.65, p=0.048). Further correction for MetS score components excluded MetS score as an independent covariate of outcomes other than death. With the limitations imposed by sample size and the strenght of long-term observation, we suggest that in T2DM MetS score predicts all-cause mortality indipendent of main risk factors and of each component of MetS. MetS score was associated with CV outcomes and ESRD, but these associations were attenuated after adjustment for its components.