Diabesity phenotype and the risks of cardiovascular disease and subclinical atherosclerosis: A prospective cohort study

Objective: The aim of this study was to investigate the associations of diabesity with incident cardiovascular disease (CVD) and subclinical atherosclerosis. Methods: The prospective cohort study included 8,006 participants without baseline CVD. Diabesity was categorized as (i) normal glucose tolerance (NGT) with nonobesity; (ii) NGT with obesity; (iii) prediabetes with nonobesity; (iv) prediabetes with obesity; (v) diabetes with nonobesity; and (vi) diabetes with obesity. The hazard ratios (HRs) for incident CVD and odds ratios (ORs) for subclinical atherosclerosis associated with diabesity categories were examined. Results: Compared with the category of NGT with nonobesity, the categories of NGT with obesity (HR 1.68; 95% CI: 1.10–2.57), diabetes with nonobesity (HR 1.42; 95% CI: 1.08–1.88), and diabetes with obesity (HR 1.78; 95% CI: 1.24–2.55) were associated with higher risks of CVD. Prediabetes with or without obesity conferred no excess risk for CVD but higher risks for subclinical atherosclerosis. The diabetes with obesity category was associated with the highest risk for elevated pulse pressure (OR 3.07; 95% CI: 2.06–4.58) and albuminuria (OR 3.39; 95% CI: 2.31–4.99), and diabetes with or without obesity showed comparable ORs for elevated brachial–ankle pulse wave velocity. Conclusions: The association patterns between diabesity and CVD risks support the value of diabesity as a prevention target for CVD.