Published online Jul 15, 2025. doi: 10.4239/wjd.v16.i7.107647
Revised: April 18, 2025
Accepted: June 3, 2025
Published online: July 15, 2025
Processing time: 110 Days and 10 Hours
Decreased renal function is a well-known risk factor for cardiovascular diseases (CVD) and death. However, the impact of diabetes duration and the glomerular filtration rate (GFR) on cardiovascular complications in patients with type 2 dia
To investigate the complex impact of longer diabetes duration and GFR on CVD and mortality.
Subjects with diabetes age ≥ 20 years, who underwent health check-ups from 2015 to 2016 were identified in the Korean National Health Insurance Service database. Based on diabetes duration, subjects were grouped into new-onset, < 5 years, 5–9 years, or ≥ 10 years. The new-onset diabetes group [estimated GFR (eGFR): ≥ 90 mL/min/1.73 m2] was the reference group. A Cox proportional hazards model adjusted for potential confounders was used to estimate the risk for myocardial infarction (MI), ischemic stroke (IS), and mortality.
During a 3.9-year follow-up of 2105228 patients, 36003 (1.7%) MIs, 46496 (2.2%) ISs, and 73549 (3.5%) deaths were documented. Both longer diabetes duration and lower eGFR were independently associated with higher risks of MI, IS, and mortality, which were further amplified when these factors coexisted. Even patients with new-onset diabetes had elevated MI and IS risk at mildly reduced eGFR (60–90 mL/min/1.73 m²). Mortality risk rose appreciably once eGFR declined below 60 mL/min/1.73 m², particularly in those with longer diabetes duration. eGFR ≥ 90 mL/min/1.73 m2 subgroups had higher death risk than eGFR 60–90 mL/min/1.73 m2 subgroups regardless of diabetic duration.
Increasing diabetes duration and decreasing eGFR are associated with increased risk of MI, IS, and mortality. For cardiovascular risk estimation, diabetes duration should be considered an important risk factor.
Core Tip: This study investigated the complex impact of longer diabetes duration and glomerular filtration rate (GFR) on cardiovascular diseases and mortality. We reveal an association between longer diabetes duration and an increased risk of myocardial infarction and ischemic stroke, even when the GFR is within the normal range. With increasing diabetes duration, mortality increased in subjects with GFR < 60 mL/min/1.73 m2. These findings highlight that for cardiovascular risk estimation, diabetes duration should be considered an important risk factor.