Cardiovascular events and mortality in patients with T2D and multimorbidity

  • Coles B & al.
  • Diabetes Obes Metab
  • 7 Oct 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • In patients with type 2 diabetes (T2D), level of multimorbidity, and in particular, cardiovascular disease (CVD) multimorbidity, was associated with an increased risk and early onset of a CVD event, mortality, and CV mortality.
  • The risk difference was highest in the year following T2D diagnosis, and the increased risk remained up to 19 years.

Why this matters

  • Physicians should identify and manage both T2D and comorbidities early on.
  • An important finding for clinical decision-making is that CVD comorbidities are the primary driver of increased risk.

Study design

  • This retrospective study included 120,409 adults newly diagnosed with T2D using data from the UK Clinical Practice Research Datalink (2000-2018).
  • Primary outcome: first fatal or non-fatal CVD event; secondary outcomes: CV and all-cause mortality.
  • Funding: Novo Nordisk.

Key results

  • Overall, 66,977 (55.6%) patients had T2D only, 37,894 (31.5%) had 1 comorbidity, 11,357 (9.4%) had 2 comorbidities, 3186 (2.6%) had 3 comorbidities and 995 (0.8%) had ≥4 comorbidities.
  • At 1 and 19 years after T2D diagnosis, the adjusted HR (aHR; 95% CI) for ≥4 comorbidities was:
    • 4.62 (4.28-4.98) and 2.57 (2.45-2.69) for a CVD event;
    • 4.44 (4.13-4.76) and 1.73 (1.68-1.78) for all-cause mortality; and
    • 6.91 (6.08-7.84) and 2.68 (2.52-2.85) for CV mortality, respectively.
  • Overall, 100,183 (83.2%) patients had no CVD comorbidities, 16,874 (14.0%) had 1 CVD comorbidity and 3352 (2.8%) had ≥2 comorbidities.
  • At 1 and 19 years after T2D diagnosis, the aHR (95% CI) for ≥2 CVD comorbidities was:
    • 4.01 (3.85-4.18) and 2.42 (2.35-2.49) for a CVD event;
    • 2.57 (2.46-2.68) and 1.44 (1.42-1.47) for all-cause mortality; and
    • 5.46 (5.10-5.85) and 2.44 (2.35-2.54) for CV mortality, respectively.

Limitations

  • Retrospective design.