Latent autoimmune diabetes and long-term risk for cardiovascular disease

  • Maddaloni E & al.
  • Diabetes Obes Metab
  • 17 May 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In adults with new-onset type 2 diabetes (T2D), the long-term risk for major adverse cardiovascular events (MACEs; death, non-fatal myocardial infarction or non-fatal stroke) was lower in those with latent autoimmune diabetes of adults (LADA).
  • However, after adjustment for conventional risk factors, MACE risk did not differ suggesting that measurement of diabetes autoantibodies (AAb) in addition to traditional cardiovascular (CV) risk factors will not aid CV risk stratification in clinically-diagnosed T2D.

Why this matters

  • LADA is diagnosed in 12% of adults with clinically diagnosed T2D, and patients with LADA tend to have a healthier cardiovascular (CV) risk profile than those without LADA, but it remains uncertain whether the risk for CV events differ between both the patients.

Study design

  • Diabetes autoantibodies (AAb) were measured in 5062 participants with newly diagnosed T2D who were recruited in the United Kingdom Prospective Diabetes Study (UKPDS).
  • The incidence of MACEs was compared between participants with LADA (e1 AAb positive; n=567) and without LADA (AAb negative; n=4495).
  • Funding: EFSD Mentorship Programme.

Key results

  • Compared with those without LADA, patients with LADA were younger, with higher mean HbA1c and high-density lipoprotein (HDL) cholesterol level and lower body mass index, total cholesterol and systolic blood pressure levels (all P<.01>
  • Over a median follow-up of 17.3 (interquartile range, 12.6-20.7) years, the incidence of MACEs was significantly lower in patients with LADA vs those without LADA (17.4 vs 23.5 per 1000 person-years; HR, 0.73; P<.001>
  • This difference was no longer significant after adjustment for age (HR, 0.86; P=.078) and other potential confounders (HR, 0.90; P=.22).

Limitations

  • Post hoc analysis.

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