Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1·9 million people

TLDR

Type 2 diabetes is linked to many cardiovascular diseases, yet their relative associations have not been compared. The study aimed to examine the associations between type 2 diabetes and 12 initial cardiovascular disease manifestations. Using linked primary care, hospital, registry, and death records from the CALIBER programme, the authors followed adults ≥30 years free of CVD from 1998 to 2010, defined first CVD presentation as the primary endpoint, and compared cumulative incidence curves and Cox models to estimate cause‑specific hazard ratios. In a cohort of 1.92 million people (1.8 % with type 2 diabetes), 113,638 first CVD events occurred over a median 5.5‑year follow‑up; type 2 diabetes was associated with higher risk of peripheral arterial disease (HR 2.98), ischemic stroke (1.72), stable angina (1.62), heart failure (1.56), and non‑fatal myocardial infarction (1.54), but lower risk of abdominal aortic aneurysm (0.46) and subarachnoid haemorrhage (0.48), and no association with arrhythmia or sudden cardiac death. The study.

Abstract

BackgroundThe contemporary associations of type 2 diabetes with a wide range of incident cardiovascular diseases have not been compared. We aimed to study associations between type 2 diabetes and 12 initial manifestations of cardiovascular disease.MethodsWe used linked primary care, hospital admission, disease registry, and death certificate records from the CALIBER programme, which links data for people in England recorded in four electronic health data sources. We included people who were (or turned) 30 years or older between Jan 1, 1998, to March 25, 2010, who were free from cardiovascular disease at baseline. The primary endpoint was the first record of one of 12 cardiovascular presentations in any of the data sources. We compared cumulative incidence curves for the initial presentation of cardiovascular disease and used Cox models to estimate cause-specific hazard ratios (HRs). This study is registered at ClinicalTrials.gov (NCT01804439).FindingsOur cohort consisted of 1 921 260 individuals, of whom 1 887 062 (98·2%) did not have diabetes and 34 198 (1·8%) had type 2 diabetes. We observed 113 638 first presentations of cardiovascular disease during a median follow-up of 5·5 years (IQR 2·1–10·1). Of people with type 2 diabetes, 6137 (17·9%) had a first cardiovascular presentation, the most common of which were peripheral arterial disease (reported in 992 [16·2%] of 6137 patients) and heart failure (866 [14·1%] of 6137 patients). Type 2 diabetes was positively associated with peripheral arterial disease (adjusted HR 2·98 [95% CI 2·76–3·22]), ischaemic stroke (1·72 [1·52–1·95]), stable angina (1·62 [1·49–1·77]), heart failure (1·56 [1·45–1·69]), and non-fatal myocardial infarction (1·54 [1·42–1·67]), but was inversely associated with abdominal aortic aneurysm (0·46 [0·35–0·59]) and subarachnoid haemorrhage (0·48 [0·26–0.89]), and not associated with arrhythmia or sudden cardiac death (0·95 [0·76–1·19]).InterpretationHeart failure and peripheral arterial disease are the most common initial manifestations of cardiovascular disease in type 2 diabetes. The differences between relative risks of different cardiovascular diseases in patients with type 2 diabetes have implications for clinical risk assessment and trial design.FundingWellcome Trust, National Institute for Health Research, and Medical Research Council.