Telomere length may predict CV risk in type 2 diabetes
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Telomere length may serve as a useful biomarker to predict risk for prevalent and incident cardiovascular complications among people with diabetes, according to findings published in Diabetes Care.
“Telomere length, which is a biomarker of biological aging, has previously been linked with the risk for type 2 diabetes,” Ronald C.W. Ma, FRCP, professor in the department of medicine and therapeutics and division head for endocrinology and diabetes at the Chinese University of Hong Kong, told Healio. “Whether telomere length is associated with the risk for cardiovascular complications in people with type 2 diabetes was not clear. This collaborative study between the Chinese University of Hong Kong and the University of Sydney, utilizing the large Hong Kong Diabetes Register with prospective follow-up over 13 years, showed that relative leukocyte telomere length was not only associated with cardiometabolic risk factors at the time of assessment, but was also associated with risk for CVD during follow-up, independent of the other risk factors.”
Ma and colleagues analyzed data from 5,349 Chinese adults with type 2 diabetes who provided DNA samples, selected from the Hong Kong Diabetes Register (45.2% men; mean age, 58 years; mean BMI, 25.3 kg/m²). Researchers measured relative leukocyte telomere length using quantitative polymerase chain reaction. CVD endpoints were defined as myocardial infarction, coronary heart disease, congestive heart failure, cerebral vascular accident and peripheral vascular disease. At baseline, 808 individuals had CVD and 1,140 developed CVD during a mean follow-up of 13.4 years.
Researchers found that relative leukocyte telomere length was correlated inversely with age, diabetes duration, blood pressure, HbA1c and urine albumin-to-creatinine ratio, whereas it was positively correlated with estimated glomerular filtration rate (P < .001 for all).
Individuals with CVD at baseline had a shorter relative leukocyte telomere length (mean, 4.3 2delta Ct) vs. those without CVD at baseline (mean, 4.6 2delta Ct; P < .001).
Among those without CVD at baseline (n = 4,541), the 1,140 who developed CVD during follow-up had a shorter relative leukocyte telomere length (mean, 4.3 2delta Ct) vs. those who remained free of CVD (mean, 4.7 2delta Ct; P < .001).
In Cox regression models, shorter relative leukocyte telomere length was associated with higher risk for incident CVD, with an HR of 1.252 for each unit decrease (95% CI, 1.195-1.311). Results persisted after adjustment for factors including age, sex, BMI, systolic BP and HbA1c, with an adjusted HR of 1.141 (95% CI, 1.084-1.2).
“It appears that a combination of different metabolic risk factors act to contribute to shortening of telomere length, which provides an assessment of the long-term CV risk in people with diabetes,” Ma said. “Incorporation of leukocyte telomere length adds to and improves upon CV risk prediction using only traditional risk factors, or risk prediction based on other risk factor-based CV risk engines.”
The researchers noted that relative leukocyte telomere length was not examined during follow-up to explore the impact of attrition rate on the risk for CVD, and an association between relative leukocyte telomere length and smoking status was not assessed.
“Future work needs to establish if telomere length is causally linked with CV risk in diabetes, or whether it is just associated with CV risk,” Ma said. “Mechanisms linking telomere shortening with other noncommunicable disease also warrant further work.”
For more information:
Ronald C.W. Ma, FRCP, can be reached at the Chinese University of Hong Kong, Department of Medicine and Therapeutics, Ninth Floor, Lui Che Woo Clinical Science Building, Room 114038, Prince of Wales Hospital, Shatin, Hong Kong; email: rcwma@edu.hk; Twitter: @drronaldma1.
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