Cardiovascular disease risk higher in optimally managed patients with T2D

Takeaway

• Optimally managed patients with type 2 diabetes (T2D) have a 21% higher risk of cardiovascular disease (CVD) compared with people without diabetes.
• The association between the degree of risk control and CVD events was much stronger in patients with T2D without cardio-renal disease than in patients with T2D and cardio-renal disease.

• Overall risk factor management was poor in patients with T2D. Greater use of guideline-driven care, clinical decision support, drug intervention and self-management support should be encouraged.

Study design

• This retrospective study included 101,749 patients with T2D and 378,938 control participants from the UK Clinical Practice Research Datalink (CPRD) database and 330,892 patients with T2D from the Scottish Care Information (SCI)-Diabetes database between 2006 and 2015.
• Following risk factor thresholds were used to define suboptimal status: current smoker; total cholesterol >4 mmol/L; triglycerides >1.7 mmol/L; glycated haemoglobin ≥53 mmol/mol (7.0%) and systolic blood pressure >140 mmHg or >130 mmHg in the presence of renal impairment, retinopathy or cerebrovascular disease.
• CVD risk associated with levels of risk factor control was assessed.
• Funding: Diabetes UK.

• Cardiovascular events were reported in 27,900 (27%) patients with T2D in CPRD, 72,520 (19%) control participants in CPRD and 101,362 (31%) patients with T2D in SCI-Diabetes database.
• In CPRD, patients with T2D and optimal risk factor control were at an increased risk of CVD events vs control participants (adjusted HR [aHR], 1.21; 95% CI, 1.12-1.29).
• In people with T2D and cardio-renal disease from CPRD and SCI-Diabetes, pooled HRs for CVD associated with 4 and 5 risk factors being elevated vs optimal risk factor control were 1.07 (95% CI, 1.03-1.11) and 1.09 (95% CI, 1.01-1.17), respectively.
• In contrast, in people with T2D and no cardio-renal disease, CVD risk was nearly 2-fold (HR, 1.96; 95% CI, 1.82-2.12) higher for those with 5 elevated risk factors.

• Retrospective design.