Association of type 2 diabetes mellitus with survival in patients with calcific aortic stenosis

Aim . To evaluate the association of type 2 diabetes mellitus (DM) with the risk of all-cause mortality in patients with calcific aortic stenosis (CAS). Material and methods . A prospective cohort study was conducted. Out of 95 patients initially recruited for the study, 71 patients with CAS aged 55 years and older hospitalised in the therapeutic and cardiology departments of two Moscow hospitals in 2023-2026 were included in the final analysis: 36 patients with type 2 DM and 35 without DM. Patients with a history of acute rheumatic fever were excluded from the study. All participants underwent clinical, laboratory, and echocardiographic examinations. After discharge, information on the patients’ condition was obtained by telephone interview and review of outpatient records. The primary endpoint was all-cause mortality. Survival analysis was performed using the Kaplan–Meier method and Cox regression. The median follow-up period was 538 [408; 670.5] days. Results . All-cause death was recorded in 11 of 36 (30.6%) patients with DM and in 5 of 35 (14.3%) patients without DM (p=0.155); the differences in survival curves did not reach statistical significance (log-rank test, p=0.137). In the univariate Cox model, type 2 DM did not demonstrate a statistically significant association with the risk of death (hazard ratio (HR) 2.192; 95% confidence interval (CI) 0.760–6.323; p=0.147); in the two-variable model adjusted for high-density lipoprotein cholesterol levels, the result also remained non-significant (HR 1.705; 95% CI 0.580–5.013; p=0.333). Patients with DM had a higher functional class of chronic heart failure (p=0.033), a lower left ventricular ejection fraction (p=0.016), and a higher wall motion score index (p=0.023); CAS severity parameters did not differ significantly (p=0.786). Conclusion . In the study sample, a statistically significant association between type 2 DM and the risk of death was not established. The numerically higher mortality rate and wide CI do not allow excluding a clinically significant effect. The results should be considered exploratory and require confirmation in studies with a larger sample size.