Longer leukocyte telomere length increases cardiovascular mortality in type 2 diabetes patients

Abstract

Aims Leukocyte telomere length (LTL), as a biomarker of biological aging, is associated with the prevalence and complications of diabetes. This study aims to investigate the associations between LTL and all‐cause and cause‐specific mortality in patients with type 2 diabetes. Methods All participants with baseline LTL records were included from the National Health and Nutrition Examination Survey 1999–2002. Death status and its causes were ascertained for National Death Index based on International Classification of Diseases, Tenth Revision code. Cox proportional hazards regression models were established to estimate the hazard ratios (HRs) of LTL associating with all‐cause and cause‐specific mortality. Results The study enrolled 804 diabetic patients with the mean follow‐up of 14.9 ± 2.59 years. There were 367 (45.6%) all‐cause deaths, 80 (10.0%) cardiovascular deaths, and 42 (5.2%) cancer‐related deaths. Longer LTL was associated with reduced all‐cause mortality, whereas this association disappeared after adjusting for other variables. Compared with the lowest tertiles of LTL, the multivariable‐adjusted hazard ratio of cardiovascular mortality was 2.11 (95% confidence interval [CI] 1.31–3.39; p < .05) in the highest tertiles. In terms of cancer mortality, the highest tertile was negatively correlated with the risk of cancer mortality (HR 0.58 [95% CI 0.37, 0.91], p < .05). Conclusion In conclusion, LTL was independently associated with the risk of cardiovascular mortality in patients with type 2 diabetes and was negatively correlated with the risk of cancer mortality. Telomere length may be a predictor of cardiovascular mortality in diabetes.

Association of leukocyte telomere length with risk of all-cause and cardiovascular mortality in middle-aged and older individuals without cardiovascular disease: a prospective cohort study of NHANES 1999–2002

“…A recently published study investigated the association between telomere length and mortality among patients with diabetes and found that TL was not significantly associated with death from any cause. The authors even found that longer TL was associated with an increased risk of CVD mortality, contradicting previous studies [ 12 ]. In our study, we examined the association between LTL and CVD mortality among middle-aged and older participants without prior CVD.…”

“…However, some studies have contradicted these findings by suggesting that LTL is not a significant risk factor for the development of cardiovascular disease (CVD) [ 10 , 11 ]. More recently, Chen et al discovered a positive association between longer LTL and increased risk of CVD mortality among patients with type-2 diabetes in the United States (US) [ 12 ]. Consequently, the role of TL in the development of age-related diseases and long-term prognosis remains controversial.…”

17-year follow-up of association between telomere length and all-cause mortality, cardiovascular mortality in individuals with metabolic syndrome: results from the NHANES database prospective cohort study

“…Shorter LTL is associated with an increased risk of mortality in contemporary humans, particularly for non-cancer causes of death such as cardiovascular disease, and LTL may serve as a marker for the natural lifespan limit in humans [ 10 ]. However, studies have found contradictory results, indicating that longer leukocyte telomere length increases the risk of cardiovascular mortality in patients with type 2 diabetes [ 11 ]. Shorter TL is strongly correlated with multiple components of metabolic syndrome, such as abdominal obesity, dyslipidemia, hyperglycemia, and overall metabolic health, and it also serves as a predictor for an unfavorable metabolic profile [ 12 , 13 ].…”