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Cardiovascular risk factors early in the course of treatment in people with type 2 diabetes without established cardiovascular disease: A population‐based observational retrospective cohort study

Kamlesh Khunti Orcid Logo, Christin L. Hertz, Lise Lotte N. Husemoen, Emina Mocevic, Rikke B. Nordsborg, Johanne S. Piltoft, Steve Bain Orcid Logo

Diabetic Medicine, Volume: 39, Issue: 3

Swansea University Author: Steve Bain Orcid Logo

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DOI (Published version): 10.1111/dme.14697

Abstract

AimsTo characterise the cardiovascular risk of people with type 2 diabetes without established cardiovascular disease but with risk factors, relative to those with established cardiovascular disease, to provide information on which patients could benefit from early use of glucose-lowering therapies...

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Published in: Diabetic Medicine
ISSN: 0742-3071 1464-5491
Published: Wiley 2022
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URI: https://cronfa.swan.ac.uk/Record/cronfa57800
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Cox proportional hazards models were used to estimate relative risks of major adverse cardiovascular events within groups defined by the presence of selected risk factors in people without versus with established cardiovascular disease.ResultsOf 53,182 individuals, 19.4% had established cardiovascular disease (i.e. a prior cardiovascular event). Over 5&#x2013;7 years&#x2019; follow-up, the rate of major adverse cardiovascular events was 14.0 and 49.6 events/1000 person-years without and with established cardiovascular disease, respectively (hazard ratio [HR] 0.28, 95% confidence interval [CI] 0.26, 0.29). Compared with a reference HR 1.0 for participants with established cardiovascular disease, estimated glomerular filtration rate &lt;60 ml/min was the single factor associated with the highest risk of major adverse cardiovascular events (HR 0.75, 95% CI 0.70, 0.81) and mortality (HR 1.12, 95% CI 1.07, 1.18) in people with type 2 diabetes without established cardiovascular disease. The combination of chronic kidney disease with older age, smoking and/or dyslipidaemia was associated with a similarly high risk of cardiovascular events in people with type 2 diabetes and without cardiovascular disease compared with those having established cardiovascular disease.ConclusionsThese analyses provide important information to identify people who may benefit from primary prevention of cardiovascular disease. 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spelling 2022-03-16T10:05:36.8887275 v2 57800 2021-09-07 Cardiovascular risk factors early in the course of treatment in people with type 2 diabetes without established cardiovascular disease: A population‐based observational retrospective cohort study 5399f4c6e6a70f3608a084ddb938511a 0000-0001-8519-4964 Steve Bain Steve Bain true false 2021-09-07 BMS AimsTo characterise the cardiovascular risk of people with type 2 diabetes without established cardiovascular disease but with risk factors, relative to those with established cardiovascular disease, to provide information on which patients could benefit from early use of glucose-lowering therapies that also reduce cardiovascular risk.MethodsData from people with type 2 diabetes initiating second-line glucose-lowering medication were retrieved from the UK Clinical Practice Research Datalink GOLD database and linked with Hospital Episode Statistics and Office for National Statistics (2001–2016). Cox proportional hazards models were used to estimate relative risks of major adverse cardiovascular events within groups defined by the presence of selected risk factors in people without versus with established cardiovascular disease.ResultsOf 53,182 individuals, 19.4% had established cardiovascular disease (i.e. a prior cardiovascular event). Over 5–7 years’ follow-up, the rate of major adverse cardiovascular events was 14.0 and 49.6 events/1000 person-years without and with established cardiovascular disease, respectively (hazard ratio [HR] 0.28, 95% confidence interval [CI] 0.26, 0.29). Compared with a reference HR 1.0 for participants with established cardiovascular disease, estimated glomerular filtration rate <60 ml/min was the single factor associated with the highest risk of major adverse cardiovascular events (HR 0.75, 95% CI 0.70, 0.81) and mortality (HR 1.12, 95% CI 1.07, 1.18) in people with type 2 diabetes without established cardiovascular disease. The combination of chronic kidney disease with older age, smoking and/or dyslipidaemia was associated with a similarly high risk of cardiovascular events in people with type 2 diabetes and without cardiovascular disease compared with those having established cardiovascular disease.ConclusionsThese analyses provide important information to identify people who may benefit from primary prevention of cardiovascular disease. Modifiable cardiovascular risk factors should be controlled early in all individuals with type 2 diabetes (as well as in all individuals with cardiovascular disease). Journal Article Diabetic Medicine 39 3 Wiley 0742-3071 1464-5491 cardiovascular disease; cardiovascular disease risk; risk factors; type 2 diabetes 1 3 2022 2022-03-01 10.1111/dme.14697 COLLEGE NANME Biomedical Sciences COLLEGE CODE BMS Swansea University Novo Nordisk A/S, Denmark 2022-03-16T10:05:36.8887275 2021-09-07T15:27:22.4111480 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Kamlesh Khunti 0000-0003-2343-7099 1 Christin L. Hertz 2 Lise Lotte N. Husemoen 3 Emina Mocevic 4 Rikke B. Nordsborg 5 Johanne S. Piltoft 6 Steve Bain 0000-0001-8519-4964 7 57800__21118__ba4ffa3a75864e5d97b4a9c00d533d4a.pdf 57800.pdf 2021-10-08T13:32:57.4969283 Output 334403 application/pdf Version of Record true © 2021 The Authors. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License true eng http://creativecommons.org/licenses/by-nc/4.0/
title Cardiovascular risk factors early in the course of treatment in people with type 2 diabetes without established cardiovascular disease: A population‐based observational retrospective cohort study
spellingShingle Cardiovascular risk factors early in the course of treatment in people with type 2 diabetes without established cardiovascular disease: A population‐based observational retrospective cohort study
Steve Bain
title_short Cardiovascular risk factors early in the course of treatment in people with type 2 diabetes without established cardiovascular disease: A population‐based observational retrospective cohort study
title_full Cardiovascular risk factors early in the course of treatment in people with type 2 diabetes without established cardiovascular disease: A population‐based observational retrospective cohort study
title_fullStr Cardiovascular risk factors early in the course of treatment in people with type 2 diabetes without established cardiovascular disease: A population‐based observational retrospective cohort study
title_full_unstemmed Cardiovascular risk factors early in the course of treatment in people with type 2 diabetes without established cardiovascular disease: A population‐based observational retrospective cohort study
title_sort Cardiovascular risk factors early in the course of treatment in people with type 2 diabetes without established cardiovascular disease: A population‐based observational retrospective cohort study
author_id_str_mv 5399f4c6e6a70f3608a084ddb938511a
author_id_fullname_str_mv 5399f4c6e6a70f3608a084ddb938511a_***_Steve Bain
author Steve Bain
author2 Kamlesh Khunti
Christin L. Hertz
Lise Lotte N. Husemoen
Emina Mocevic
Rikke B. Nordsborg
Johanne S. Piltoft
Steve Bain
format Journal article
container_title Diabetic Medicine
container_volume 39
container_issue 3
publishDate 2022
institution Swansea University
issn 0742-3071
1464-5491
doi_str_mv 10.1111/dme.14697
publisher Wiley
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description AimsTo characterise the cardiovascular risk of people with type 2 diabetes without established cardiovascular disease but with risk factors, relative to those with established cardiovascular disease, to provide information on which patients could benefit from early use of glucose-lowering therapies that also reduce cardiovascular risk.MethodsData from people with type 2 diabetes initiating second-line glucose-lowering medication were retrieved from the UK Clinical Practice Research Datalink GOLD database and linked with Hospital Episode Statistics and Office for National Statistics (2001–2016). Cox proportional hazards models were used to estimate relative risks of major adverse cardiovascular events within groups defined by the presence of selected risk factors in people without versus with established cardiovascular disease.ResultsOf 53,182 individuals, 19.4% had established cardiovascular disease (i.e. a prior cardiovascular event). Over 5–7 years’ follow-up, the rate of major adverse cardiovascular events was 14.0 and 49.6 events/1000 person-years without and with established cardiovascular disease, respectively (hazard ratio [HR] 0.28, 95% confidence interval [CI] 0.26, 0.29). Compared with a reference HR 1.0 for participants with established cardiovascular disease, estimated glomerular filtration rate <60 ml/min was the single factor associated with the highest risk of major adverse cardiovascular events (HR 0.75, 95% CI 0.70, 0.81) and mortality (HR 1.12, 95% CI 1.07, 1.18) in people with type 2 diabetes without established cardiovascular disease. The combination of chronic kidney disease with older age, smoking and/or dyslipidaemia was associated with a similarly high risk of cardiovascular events in people with type 2 diabetes and without cardiovascular disease compared with those having established cardiovascular disease.ConclusionsThese analyses provide important information to identify people who may benefit from primary prevention of cardiovascular disease. Modifiable cardiovascular risk factors should be controlled early in all individuals with type 2 diabetes (as well as in all individuals with cardiovascular disease).
published_date 2022-03-01T04:13:49Z
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