LEADER 5: prevalence and cardiometabolic impact of obesity in cardiovascular high-risk patients with type 2 diabetes mellitus: baseline global data from the LEADER trial

Abstract

Background: Epidemiological data on obesity are needed, particularly in patients with type 2 diabetes mellitus (T2DM) and high cardiovascular (CV) risk. We used the baseline data of liraglutide effect and action in diabetes: evaluation of CV outcome results-A long term Evaluation (LEADER) (a clinical trial to assess the CV safety of liraglutide) to investigate: (i) prevalence of overweight and obesity; (ii) relationship of the major cardiometabolic risk factors with anthropometric measures of adiposity [body mass index (BMI) and waist circumference (WC)]; and (iii) cardiometabolic treatment intensity in relation to BMI and WC.

Methods: LEADER enrolled two distinct populations of high-risk patients with T2DM in 32 countries: (1) aged ≥50 years with prior CV disease; (2) aged ≥60 years with one or more CV risk factors. Associations of metabolic variables, demographic variables and treatment intensity with anthropometric measurements (BMI and WC) were explored using regression models (ClinicalTrials.gov identifier: NCT01179048).

Results: Mean BMI was 32.5 ± 6.3 kg/m(2) and only 9.1 % had BMI <25 kg/m(2). The prevalence of healthy WC was also extremely low (6.4 % according to International Joint Interim Statement for the Harmonization of the Metabolic Syndrome criteria). Obesity was associated with being younger, female, previous smoker, Caucasian, American, with shorter diabetes duration, uncontrolled blood pressure (BP), antihypertensive agents, insulin plus oral antihyperglycaemic treatment, higher levels of triglycerides and lower levels of high-density lipoprotein cholesterol.

Conclusions: Overweight and obesity are prevalent in high CV risk patients with T2DM. BMI and WC are related to the major cardiometabolic risk factors. Furthermore, treatment intensity, such as insulin, statins or oral antihypertensive drugs, is higher in those who are overweight or obese; while BP and lipid control in these patients are remarkably suboptimal. LEADER confers a unique opportunity to explore the longitudinal effect of weight on CV risk factors and hard endpoints.

Fig. 1

Percentage of patients with cardiometabolic parameters at target among (a) BMI and (b) WC categories. Statistics. p values of BMI or WC vs. factors were calculated using Chi square test.***p < 0.0001; **p < 0.001; *p < 0.01. ATPIII, adult treatment panel III criteria; BMI, body mass index; BP, blood pressure; HbA1c, glycated haemoglobin; HDL-C, high-density lipoprotein cholesterol; IISHMS, International Joint Interim Statement for the Harmonization of the Metabolic Syndrome criteria; LDL-C, low-density lipoprotein cholesterol; OADs, oral antihyperglycaemic drugs; TG, triglycerides; WC, waist circumference

Fig. 2

Percentage of patients with relevant medication among (a) BMI and (b) WC categories. Statistics. p values of BMI or WC vs. factors were calculated using Chi square.***p < 0.0001; **p < 0.001; *p < 0.01. ATPIII, adult treatment panel III criteria; BMI, body mass index; IISHMS, International Joint Interim Statement for the Harmonization of the Metabolic Syndrome criteria; OADs, oral antihyperglycaemic drugs; WC, waist circumference

Fig. 3

Prevalence of patients who are overweight, obesity grade I, obesity grade II and obesity grade III* and with abdominal obesity. *The sum of the prevalence of patients in BMI obesity grades equal 100 %. ATPIII, adult treatment panel III criteria; BMI, body mass index; IISHMS, International Joint Interim Statement for the Harmonization of the Metabolic Syndrome criteria; WC, waist circumference