{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T18:00:56Z","timestamp":1792519256846,"version":"4.5.0"},"reference-count":63,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,6,4]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Diabetic vascular complications share common pathophysiological mechanisms, but the relationship between diabetes\u2010related macrovascular complications (MacroVCs) and incident diabetic microvascular complications remains unclear. We aimed to investigate the impact of MacroVCs on the risk of microvascular complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">There were 1518 participants with type 1 diabetes (T1D) and 20\u2009802 participants with type 2 diabetes from the UK Biobank included in this longitudinal cohort study. MacroVCs were defined by the presence of macrovascular diseases diagnosed after diabetes at recruitment, including coronary heart disease, peripheral artery disease, stroke, and \u22652 MacroVCs. The primary outcome was incident microvascular complications, a composite of diabetic retinopathy, diabetic kidney disease, and diabetic neuropathy. During a median (interquartile range) follow\u2010up of 11.61 (5.84\u201313.12) years and 12.2 (9.50\u201313.18) years, 596 (39.3%) and 4113 (19.8%) participants developed a primary outcome in T1D and type 2 diabetes, respectively. After full adjustment for conventional risk factors, Cox regression models showed significant associations between individual as well as cumulative MacroVCs and the primary outcome, except for coronary heart disease in T1D (T1D: diabetes coronary heart disease: 1.25 [0.98\u20131.60]; diabetes peripheral artery disease: 3.00 [1.86\u20134.84]; diabetes stroke: 1.71 [1.08\u20132.72]; \u22652: 2.57 [1.66\u20133.99]; type 2 diabetes: diabetes coronary heart disease: 1.59 [1.38\u20131.82]; diabetes peripheral artery disease: 1.60 [1.01\u20132.54]; diabetes stroke: 1.50 [1.13\u20131.99]; \u22652: 2.66 [1.92\u20133.68]). Subgroup analysis showed that strict glycemic (glycated hemoglobin &lt;6.5%) and blood pressure (&lt;140\/90\u2009mm\u2009Hg) control attenuated the association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Individual and cumulative MacroVCs confer significant risk of incident microvascular complications in patients with T1D and type 2 diabetes. Our results may facilitate cost\u2010effective high\u2010risk population identification and development of precise prevention strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.123.032626","type":"journal-article","created":{"date-parts":[[2024,5,31]],"date-time":"2024-05-31T07:17:02Z","timestamp":1717139822000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":41,"title":["Diabetes\u2010Related Macrovascular Complications Are Associated With an Increased Risk of Diabetic Microvascular Complications: A Prospective Study of 1518 Patients With Type 1 Diabetes and 20\u2009802 Patients With Type 2 Diabetes in the UK Biobank"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4291-7453","authenticated-orcid":false,"given":"Xinyu","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shanghai People\u2019s Republic of China"},{"name":"National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuzhi","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shanghai People\u2019s Republic of China"},{"name":"National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2534-9466","authenticated-orcid":false,"given":"Yikeng","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shanghai People\u2019s Republic of China"},{"name":"National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingming","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shanghai People\u2019s Republic of China"},{"name":"National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1319-1454","authenticated-orcid":false,"given":"Bo","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shanghai People\u2019s Republic of China"},{"name":"National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7069-170X","authenticated-orcid":false,"given":"Chenxin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shanghai People\u2019s Republic of China"},{"name":"National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyu","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shanghai People\u2019s Republic of China"},{"name":"National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xun","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shanghai People\u2019s Republic of China"},{"name":"National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haibin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism Shanghai 10th People\u2019s Hospital Tongji University Shanghai People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6634-3275","authenticated-orcid":false,"given":"Yili","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shanghai People\u2019s Republic of China"},{"name":"National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuandi","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology Shanghai Ninth People\u2019s Hospital Shanghai JiaoTong University School of Medicine Shanghai People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8435-0240","authenticated-orcid":false,"given":"Zhi","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shanghai People\u2019s Republic of China"},{"name":"National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai People\u2019s Republic of China"},{"name":"Ningde Municipal Hospital Ningde Normal University Ningde People\u2019s Republic of China"},{"name":"Fujian Medical University Fuzhou Fujian People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","volume-title":"IDF Diabetes Atlas","author":"Edition I. International Diabetes Federation","year":"2017","unstructured":"Edition I. International Diabetes Federation . IDF Diabetes Atlas. 8th ed. Brussels, Belgium: International Diabetes Federation; 2017.","edition":"8"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2017.151"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)62124-3"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2022.02.001"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-019-0092-1"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(16)30010-9"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-021-01841-z"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(19)30411-5"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.54.6.1615"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-3104"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(16)30057-2"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41392-023-01400-z"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12902-021-00769-8"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mvr.2021.104162"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-016-0446-x"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-017-0574-y"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/1479164115590559"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-022-02234-2"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60404-8"},{"key":"e_1_3_2_21_2","unstructured":"Collins R. UK Biobank: Protocol for a Large\u2010Scale Prospective Epidemiological Resource. 2007."},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc19-2363"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-019-09572-5"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2015.18"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc22-0177"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2016.105"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41588-020-0637-y"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-022-01790-7"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc19-1850"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.2337\/db21-0839"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.52239"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1004135"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc22-0513"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc19-1836"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.05.004"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n604"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw106"},{"key":"e_1_3_2_38_2","first-page":"2023","article-title":"Hypertension in adults: diagnosis and management","volume":"136","author":"Excellence NIfHaC","year":"2019","unstructured":"Excellence NIfHaC . Hypertension in adults: diagnosis and management. Ng. 2019;136:2023.","journal-title":"Ng"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.7326\/AITC201712050"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/81.3.515"},{"key":"e_1_3_2_41_2","unstructured":"Excellence NIfHaC . Type 1 diabetes in adults: diagnosis and management. 2015 2023."},{"key":"e_1_3_2_42_2","unstructured":"Excellence NIfHaC . Type 2 diabetes in adults: management. 2015 2023."},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc21-S011"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2016.12"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1080\/10543406.2014.920859"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0122022"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.118.11769"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00421-018-3972-2"},{"key":"e_1_3_2_49_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc18-1236"},{"key":"e_1_3_2_50_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00739.2014"},{"key":"e_1_3_2_51_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajh\/hpx091"},{"key":"e_1_3_2_52_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.110.223545"},{"key":"e_1_3_2_53_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.104.509224"},{"key":"e_1_3_2_54_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.redox.2020.101799"},{"key":"e_1_3_2_55_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.756189"},{"key":"e_1_3_2_56_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-019-4959-1"},{"key":"e_1_3_2_57_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc11-1909"},{"key":"e_1_3_2_58_2","doi-asserted-by":"publisher","DOI":"10.2337\/db07-1618"},{"key":"e_1_3_2_59_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc18-2308"},{"key":"e_1_3_2_60_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(17)30221-8"},{"key":"e_1_3_2_61_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-2586"},{"key":"e_1_3_2_62_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc12-0958"},{"key":"e_1_3_2_63_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h5441"},{"key":"e_1_3_2_64_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwx246"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.123.032626","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T12:36:14Z","timestamp":1717504574000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.123.032626"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,4]]},"references-count":63,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2024,6,4]]}},"alternative-id":["10.1161\/JAHA.123.032626"],"URL":"https:\/\/doi.org\/10.1161\/jaha.123.032626","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,4]]},"assertion":[{"value":"2024-01-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-04-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-31","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e032626"}}