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Published on: February 28, 2013
Incidence of cardiovascular events and vascular interventions in patients with type 2 diabetes
Suzanne E Engelen1, Yolanda van der Graaf2, Manon C Stam-Slob1
1Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Insights
Patients with type 2 diabetes (T2DM) and cardiovascular disease (CVD) face significantly higher risks of cardiovascular events and interventions. This highlights the critical need for enhanced prevention and treatment strategies in this high-risk population.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Public Health
Background:
- Diabetes mellitus significantly elevates cardiovascular morbidity and mortality risks.
- The precise vascular burden in patients with type 2 diabetes (T2DM) remains incompletely quantified.
- Cardiovascular disease (CVD) further exacerbates vascular risks in diabetic patients.
Purpose of the Study:
- To evaluate and compare the incidence rates of cardiovascular events (CVE) and vascular interventions.
- To assess these rates in patients with T2DM, with and without pre-existing CVD.
- To compare these incidence rates against high-risk patients without T2DM.
Main Methods:
- Analysis of a prospective cohort of 9,808 high-risk patients from the SMART study.
- Calculation of incidence rates for CVE (vascular death, stroke, myocardial infarction) and vascular interventions (PCI, CABG, peripheral interventions, amputation).
- Adjustment for confounders using Poisson regression models.
Main Results:
- Patients with T2DM and CVD exhibited a 4-fold higher incidence of CVE and an 8-fold higher incidence of vascular interventions compared to those without T2DM or CVD.
- Incidence rates for the composite of non-fatal MI, non-fatal stroke, and vascular death ranged from 5.8 to 40.7 per 1000 person-years across patient groups.
- A consistent increase in the incidence of all vascular interventions was observed with the presence of T2DM and CVD.
Conclusions:
- Both T2DM and CVD independently increase the incidence of cardiovascular events and interventions.
- The combination of T2DM and CVD presents the highest risk for new cardiovascular diseases and interventions.
- Optimal risk factor management and novel prevention/treatment strategies are crucial for this high-risk population.
Objective:
Diabetes mellitus is associated with an increased risk for cardiovascular morbidity and mortality. The vascular burden in terms of incidence of cardiovascular events (CVE) and vascular interventions is however poorly quantified. In this study we evaluated the incidence rates of CVE and vascular interventions in patients with type 2 diabetes (T2DM) with and without cardiovascular disease (CVD) in comparison to patients without type 2 diabetes.
Research Design And Methods:
In a cohort of 9.808 high-risk patients with and without cardiovascular disease and type 2 diabetes originated from the ongoing, single-center prospective SMART (Second Manifestations of ARTerial disease) cohort, the number and incidence rates of CVE and interventions were calculated. The incidence rates were adjusted for confounders using Poisson regression models. CVE were defined as vascular death, stroke and myocardial infarction (MI). Interventions were defined as percutaneous coronary intervention, coronary artery bypass grafting, percutaneous transluminal angioplasty or stenting of the peripheral arteries and amputation.
Results:
Patients with T2DM and CVD had a 4-fold higher incidence rate of CVE and a 8-fold higher incidence rate of vascular interventions compared to high-risk patients without T2DM and CVD after adjusting for confounders. The incidence rate for the composite of non-fatal MI, non-fatal stroke and vascular death was 5.8 per 1000person-years in patients without T2DM or CVD at baseline, 15.2 per 1000person-years in patients with T2DM but without CVD at baseline, 26.0 per 1000person-years in patients without T2DM but with CVD and 40.7 per 1000person-years in patients with both T2DM and CVD at baseline. A similar increasing incidence rate was seen for all vascular interventions from patients without T2DM or CVD to patients with both T2DM and CVD.
Conclusions:
Patients with type 2 diabetes or CVD are subject to an increased incidence of cardiovascular events and interventions compared to high-risk patients without type 2 diabetes or vascular disease. Patients with type 2 diabetes and CVD have the highest incidence of new cardiovascular diseases and vascular interventions when compared to patients without type 2 diabetes and CVD. These results underline the need for optimal risk factor treatment as well as the need for new prevention and treatment strategies in this very high risk population.
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