Objective To explore the effects of hypertension combined with atherosclerosis on the risk of cardiovascular disease (CVD) in diabetic population.

Methods A total of 10 058 patients with diabetes who participated in the Kailuan study and completed brachial-ankle pulse wave velocity (baPWV) testing were included for statistical analysis. The subjects were divided into the non-hypertension non-atherosclerosis group (control group), hypertension group, atherosclerosis group, and hypertension combined with atherosclerosis group based on their history of hypertension and atherosclerosis (baPWV≥1 400 cm/s).

Results At a median follow-up of 4.15 years, 438 cases of CVD occurred, and the incidence of CVD in the total population was 8.57/1 000 person-years. The incidence of CVD in the control, hypertension, atherosclerosis, and hypertension combined with atherosclerosis groups were 2.11/1 000 person-years, 4.92/1 000 person-years, 6.69/1 000 person-years, and 11.03/1 000 person-years, respectively (χ²=60.17, P＜0.01). Compared with the control group, the multivariate Cox proportional risk regression model showed that the hazard ratio (HR) for CVD in the hypertension combined with atherosclerosis group was 3.12 95% confidence interval (CI): 1.72–5.67. Subgroup analysis showed that in the non-elderly (＜60 years) subgroup, compared with the control group, the HR (95%CI) for CVD was 5.03 (2.18–11.62) in the hypertension combined with atherosclerosis group, in the elderly (≥60 years) subgroup, the HR (95%CI) was 1.02 (0.45–2.32); in the female subgroup, the HR (95%CI) was 3.45 (1.19–9.99), and in the male subgroup, the HR (95%CI) was 3.08 (1.49–6.33).

Conclusions Patients with diabetes exposed to both hypertension and atherosclerosis have an increased cardiovascular disease risk. The risk is stronger in the elderly and female populations.