Risk for CVD events elevated years before type 2 diabetes diagnosis
A Danish study found that patients with type 2 diabetes had a twofold higher prevalence of cardiovascular disease (CVD) events as long as three decades before their diagnosis versus matched comparators.
Patients with type 2 diabetes are at higher risk for cardiovascular disease (CVD) events for decades before their diagnosis, a new study found.
Researchers in Denmark did a combined case-control and cohort study that included all patients diagnosed with type 2 diabetes between 2010 and 2015 and matched them with patients from the general population by age and sex. The goal of the study was to assess the occurrence of CVD, defined as myocardial infarction or ischemic stroke, before and after a type 2 diabetes diagnosis. Conditional logistic regression was used to compute odds ratios (ORs) for prevalence of CVD in the 30-year period before type 2 diabetes diagnosis, while hazard ratios (HRs) for five-year CVD incidence after diagnosis were calculated by using Cox proportional hazards regression models. The results were published Nov. 25 by JACC.
Overall, 127,092 patients with type 2 diabetes and 381,023 matched controls and cohort patients were included in the study. Fifty-four percent were men, and median age at the index date was 62 years. In the 30 years before type 2 diabetes diagnosis, 14,179 (11.2%) who developed type 2 diabetes and 17,871 (4.7%) matched comparators had a CVD event. Prevalence of CVD was higher in patients with type 2 diabetes during the entire period before diabetes diagnosis (ORs, 2.18 [95% CI, 1.91 to 2.48] 25 to 30 years before to 2.96 [95% CI, 2.85 to 3.08] less than five years before). Five-year incidence of CVD was increased in patients with type 2 diabetes after their diabetes diagnosis compared to those without diabetes (HR, 2.20; 95% CI, 2.12 to 2.27).
The study took place in a country with universal health care and low CVD risk, among other limitations, the authors noted. They concluded that patients with type 2 diabetes had twofold more CVD events than matched comparators beginning three decades before a type 2 diabetes diagnosis. “This implies that part of the elevated CVD risk associated with T2DM [type 2 diabetes] is attributable to factors associated with the development of T2DM rather than the condition itself,” the authors wrote. “Together, these data propose a need for much earlier initiation of comprehensive preventive strategies to prevent CVD in individuals at high risk of developing CVD and T2DM.”
An accompanying editorial said the study results have significant implications and that the global burden of metabolic multimorbidity chronic conditions (MMMCCs) is a public health crisis. The editorialist called for urgent action, including systems-based approaches, integrated clinical care, a robust public health infrastructure, and investment in health equity. “The clock continues to tick, not only for individuals living with MMMCCs but also for a global population at increasing risk,” the editorial said. “This is cause for concern. Our window of opportunity is now. We cannot be a minute too late.”