Independent linear association between flow-mediated dilation and predicted intermediate-to-high 10-year ASCVD risk in patients with type 2 diabetes: a retrospective study
1The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.
Background:
Vascular endothelial dysfunction precedes atherosclerosis in type 2 diabetes (T2DM). However, the specific nature of the association between flow-mediated dilation (FMD) and the intermediate-to-high 10-year atherosclerotic cardiovascular disease (ASCVD) risk remains to be fully elucidated. This study aimed to investigate this correlation in a large sample of Chinese patients with T2DM.
Methods:
We retrospectively analyzed 1,272 T2DM patients managed at the National Metabolic Management Center (MMC) between March 2020 and March 2025. Endothelial function was assessed via brachial artery FMD (dysfunction: FMD < 6.5%). Multivariate linear and logistic regressions identified independent factors. Restricted cubic spline (RCS) models assessed non-linear associations between FMD and the intermediate-to-high 10-year ASCVD risk.
Results:
Overall, 78.9% (n=1,003) exhibited endothelial dysfunction. Multivariate analysis identified older age, higher systolic blood pressure, male sex, smoking, hypertension, and the intermediate-to-high ASCVD risk were independently associated with impaired FMD (all p < 0.05). FMD showed an independent inverse association with intermediate-to-high 10-year ASCVD risk (OR = 0.90, 95% CI: 0.82-0.99, p < 0.05) and moderate discriminative ability (AUC = 0.700, 95% CI: 0.66-0.75). Crucially, RCS analysis confirmed a linear negative correlation between FMD and the intermediate-to-high ASCVD risk (p-overall = 0.004), with no evidence of non-linearity (p-non-linear = 0.653).
Conclusions:
Endothelial dysfunction is highly prevalent in T2DM. FMD was independently, inversely and linearly associated with the intermediate-to-high calculated 10-year ASCVD risk.
