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Peer-reviewedCC BY 4.0Frontiers in Endocrinology

Independent linear association between flow-mediated dilation and predicted intermediate-to-high 10-year ASCVD risk in patients with type 2 diabetes: a retrospective study

  • Hou KJ1
  • Shen SY1,2
  • Zong CY1
  • Wang AY3
  • Hu Y4
  • Song YX4
  • Wu XH4
4 affiliations
  1. 1The Second Clinical Medical College, Zhejiang Chinese Medical University
  2. 2Tongxiang Hospital of Traditional Chinese Medicine, Tongxiang
  3. 3Hangzhou Normal University
  4. 4Geriatric Medicine Center, Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Department of Endocrinology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou
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Abstract

Background: Vascular endothelial dysfunction precedes atherosclerosis in type 2 diabetes (T2DM). However, the specific nature of the association between flow-mediated dilation (FMD) and the intermediate-to-high 10-year atherosclerotic cardiovascular disease (ASCVD) risk remains to be fully elucidated. This study aimed to investigate this correlation in a large sample of Chinese patients with T2DM.

Methods: We retrospectively analyzed 1,272 T2DM patients managed at the National Metabolic Management Center (MMC) between March 2020 and March 2025. Endothelial function was assessed via brachial artery FMD (dysfunction: FMD < 6.5%). Multivariate linear and logistic regressions identified independent factors. Restricted cubic spline (RCS) models assessed non-linear associations between FMD and the intermediate-to-high 10-year ASCVD risk.

Results: Overall, 78.9% (n=1,003) exhibited endothelial dysfunction. Multivariate analysis identified older age, higher systolic blood pressure, male sex, smoking, hypertension, and the intermediate-to-high ASCVD risk were independently associated with impaired FMD (all p < 0.05). FMD showed an independent inverse association with intermediate-to-high 10-year ASCVD risk (OR = 0.90, 95% CI: 0.82-0.99, p < 0.05) and moderate discriminative ability (AUC = 0.700, 95% CI: 0.66–0.75). Crucially, RCS analysis confirmed a linear negative correlation between FMD and the intermediate-to-high ASCVD risk ( p -overall = 0.004), with no evidence of non-linearity ( p -non-linear = 0.653).

Conclusions: Endothelial dysfunction is highly prevalent in T2DM. FMD was independently, inversely and linearly associated with the intermediate-to-high calculated 10-year ASCVD risk.

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Cite

BibTeXRIS
BibTeX
@article{hou2026independent,
  title = {{Independent linear association between flow-mediated dilation and predicted intermediate-to-high 10-year ASCVD risk in patients with type 2 diabetes: a retrospective study}},
  author = {Hou KJ and Shen SY and Zong CY and Wang AY and Hu Y and Song YX and Wu XH},
  journal = {Frontiers in Endocrinology},
  year = {2026},
  month = oct,
  doi = {10.3389/fendo.2026.1986597},
  url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1986597/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Independent linear association between flow-mediated dilation and predicted intermediate-to-high 10-year ASCVD risk in patients with type 2 diabetes: a retrospective study
AU  - Hou KJ
AU  - Shen SY
AU  - Zong CY
AU  - Wang AY
AU  - Hu Y
AU  - Song YX
AU  - Wu XH
PY  - 2026
DA  - 2026/10/14
JO  - Frontiers in Endocrinology
DO  - 10.3389/fendo.2026.1986597
UR  - https://www.frontiersin.org/articles/10.3389/fendo.2026.1986597/full
AB  - Background: Vascular endothelial dysfunction precedes atherosclerosis in type 2 diabetes (T2DM). However, the specific nature of the association between flow-mediated dilation (FMD) and the intermediate-to-high 10-year atherosclerotic cardiovascular disease (ASCVD) risk remains to be fully elucidated. This study aimed to investigate this correlation in a large sample of Chinese patients with T2DM.  Methods: We retrospectively analyzed 1,272 T2DM patients managed at the National Metabolic Management Center (MMC) between March 2020 and March 2025. Endothelial function was assessed via brachial artery FMD (dysfunction: FMD < 6.5%). Multivariate linear and logistic regressions identified independent factors. Restricted cubic spline (RCS) models assessed non-linear associations between FMD and the intermediate-to-high 10-year ASCVD risk.  Results: Overall, 78.9% (n=1,003) exhibited endothelial dysfunction. Multivariate analysis identified older age, higher systolic blood pressure, male sex, smoking, hypertension, and the intermediate-to-high ASCVD risk were independently associated with impaired FMD (all p < 0.05). FMD showed an independent inverse association with intermediate-to-high 10-year ASCVD risk (OR = 0.90, 95% CI: 0.82-0.99, p < 0.05) and moderate discriminative ability (AUC = 0.700, 95% CI: 0.66–0.75). Crucially, RCS analysis confirmed a linear negative correlation between FMD and the intermediate-to-high ASCVD risk ( p -overall = 0.004), with no evidence of non-linearity ( p -non-linear = 0.653).  Conclusions: Endothelial dysfunction is highly prevalent in T2DM. FMD was independently, inversely and linearly associated with the intermediate-to-high calculated 10-year ASCVD risk.
SN  - 1664-2392
ER  -