The association between cardiovascular outcomes and zinc deficiency among patients with type 2 diabetes: A retrospective cohort study

Abstract

Objective: This study aimed to investigate whether zinc deficiency (ZD) is associated with an increased risk of all-cause mortality and cardiovascular outcomes in patients with type 2 diabetes (T2D).

Methods: We conducted a retrospective cohort study using the TriNetX database. Patients aged 18 years or older with T2D and zinc measurement were included. The index date was defined as the first zinc measurement following the T2D diagnosis. Individuals were categorized into ZD (serum zinc <70 μg/dL) or control (70-120 μg/dL) groups. Propensity score matching (PSM) was employed to ensure comparability between groups. The primary outcomes were all-cause mortality and a composite of cardiovascular outcomes, including cerebrovascular complications, arrhythmia, inflammatory heart disease, ischemic heart disease, other cardiac disorders (heart failure, non-ischemic cardiomyopathy, cardiac arrest, and cardiogenic shock), and thrombotic disorders. Secondary outcomes included individual cardiovascular event. Hazard ratios (HRs) and 95 % confidence intervals (CIs) were calculated to assess outcome risks.

Results: Out of 23,041 eligible patients, 9503 had ZD and 13,538 had normal zinc levels; after PSM, 7886 patients remained in each group. Compared with the control group, the ZD group had a higher incidence rate of all-cause mortality (HR, 2.08; 95 % CI, 1.72-2.51; p < 0.001) and composite of cardiovascular outcomes (HR, 1.15; 95 % CI, 1.08-1.24; p < 0.001). The ZD group also exhibited increased rates of arrhythmia (HR, 1.20; 95 % CI, 1.10-1.32; p < 0.001), inflammatory heart disease (HR, 1.54; 95 % CI, 1.07-2.21; p < 0.001), and other cardiac disorders (HR, 1.23; 95 % CI, 1.08-1.40; p < 0.001).

Conclusion: ZD in T2D patients is associated with a significantly higher risk of all-cause mortality and cardiovascular complications. These findings underscore the potential clinical importance of monitoring and addressing zinc status in the management of patients with T2D.

Keywords: All-cause mortality; Cardiovascular disease; Micronutrients; Type 2 diabetes; Zinc deficiency.