PhD defence K. (Kan) Wang

Summary:

The aims of this thesis were to investigate the role of cardiometabolic health in type 2 diabetes (T2D) development, and to investigate the implication of blood pressure management in T2D and the burden of complications across the glycemic spectrum. 

Cardiometabolic risk factors, including heart rate and heart rate variability, relative fat mass,  arterial stiffness and remodelling markers, were significantly associated with incident T2D. And adhering to favorable cardiovascular health (CVH) in midlife could lower the remaining lifetime risk for incident T2D, regardless of T2D genetic predisposition. Regarding the hypertension management in T2D, only a modest degree of discordance between the 2020 Chinese Diabetes Society, the 2022 American Diabetes Association, and the 2017 American College of Cardiology/American Heart Association guidelines were found among middle-aged and older Chinese with diabetes. In addition, the lowest risk of death was consistently observed around 130~140 mmHg for systolic blood pressure and 80~90 mmHg for diastolic blood pressure within different multimorbidity patterns. Regarding the related complications, hyperglycemia status, either prediabetes or T2D, carried a large lifetime risk for incident cardiovascular disease (CVD). In addition, compared to normoglycemia, baseline T2D was also associated with a faster decline in orientation and physical function. Prediabetes is independently associated with an increased risk of atherosclerotic cardiovascular disease and mortality, and favorable lifestyle habits could lower the risk of transitioning to CVD and mortality among people with prediabetes. Adherence to favorable CVH would infer a lower lifetime risk of cardiovascular and non-cardiovascular diseases.