Aortic stiffness, inflammation, denutrition and type 2 diabetes in the elderly

Observational studies in the elderly have shown that some of the classical cardiovascular (CV) risk factors are difficult to interpret. Thus, our study investigated whether increased aortic stiffness is associated with higher mortality risk in both the diabetic and non-diabetic elderly before and after adjusting for geriatric confounders such as inflammation (sedimentation rate, C-reactive protein, orosomucoid levels, leukocyte count) and denutrition parameters (body weight, body mass index [BMI], plasma albumin and prealbumin).

In a cohort of 324 (84 men) hospitalized elderly subjects, including 255 non-diabetic and 69 diabetic subjects, aortic stiffness was assessed by carotid-femoral pulse wave velocity (PWV) together with CV risk factors. Subjects were studied over a 2-year mean follow-up period, thus enabling evaluation of long-term all-cause mortality.

A total of 105 subjects died during the follow-up. Kaplan-Meier curves showed a significantly higher mortality in the diabetics (P=0.024). Multivariate Cox analyses differed for non-diabetic subjects and diabetics. In the former, the hazard ratio (HR) for an increase of 1 SD (with confidence intervals) was 1.36 (1.07-1.72) for PWV, 0.73 (0.52-1.01) for plasma albumin and 0.63 (0.45-0.89) for BMI. In diabetic patients, the HR was 1.60 (1.02-2.50) for leukocyte count, 1.75 (1.03-2.96) for orosomucoid levels and 0.32 (0.15-0.68) for BMI.

In this very elderly population, although marginally significant on crude analysis, PWV, but not systolic or pulse pressure, was a powerful determinant of total mortality after taking into account the important role of type 2 diabetes. In diabetics, inflammation and denutrition predominated over mechanical factors.