Sense of vitality is associated with cardiovascular events in type 2 diabetes independently of traditional risk factors and arterial stiffness

Aims The aim of this study was to determine if single items in the quality of life questionnaire short form 36 (SF36) were associated with cardiovascular events in patients with type 2 diabetes mellitus (T2DM). Methods In 756 T2DM patients (260 women) from the CARDIPP study, nine questions from the domains vitality and well-being in SF36 were analysed. Patients, 55-66 years, were recruited in 2005-2008 and followed up until 31 December 2018 for the incidence of major adverse cardiovascular events (MACE), that is, myocardial infarction, stroke or cardiovascular death. Results Median follow-up time: 11.6 years, during which 119 (16%) MACE occurred. The SF36 items: seldom full of pep (HR 1.2, 95% CI: 1.1-1.4, p = 0.006), seldom a lot of energy (HR 1.3, 95%CI: 1.1-1.5, p < 0.001), worn out (HR 1.2, 95%CI: 1.0-1.4, p = 0.020) and seldom happy (HR 1.2, 95%CI: 1.0-1.4, p = 0.012) were independent risk factors for MACE in separate models, as well as male sex, diabetes duration, HbA(1c), sagittal abdominal diameter and aortic pulse wave velocity. The variables seldom full of pep and seldom a lot of energy remained associated with MACE when conducting separate analyses for sexes. Only seldom a lot of energy remained associated with MACE when all items from SF-36 were comprised in the same model. Conclusions One single question regarding energy levels from SF36 may be used as an independent risk factor for cardiovascular events in T2DM patients in primary care, for both men and women. This item may be included in future risk assessment for use in clinical practice for cardiovascular risk stratification of T2DM patients. Trial registration The study was registered in (NCT 01049737) in 14 January 2010.Funding Agencies|Medical Research Council in Southeast Sweden; Futurum; GE Healthcare; Swedish Heart-Lung Foundation; King Gustaf V and Queen Victoria Freemason Foundation; Swedish Research Council [12661]; County Council of Ostergotland; Linkoping University