Diabetes, hypertension, and cardiovascular disease development

Area of Science:

• Cardiology
• Endocrinology
• Public Health

Background:

• Type 2 diabetes mellitus (T2DM) and hypertension (HTN) are significant risk factors for cardiovascular disease (CVD).
• The interplay between T2DM and HTN, particularly the sequence of their development, requires further investigation regarding CVD risk.
• Understanding these relationships is crucial for effective patient management and public health strategies.

Purpose of the Study:

• To compare cardiovascular risks in individuals with T2DM and subsequent HTN versus those with T2DM alone.
• To compare cardiovascular risks in individuals with HTN and subsequent T2DM versus those with HTN alone.
• To evaluate CVD risks in patients with comorbid T2DM and HTN based on the primary diagnosis history.

Main Methods:

• A nationwide retrospective cohort study using Taiwan's National Health Insurance Research Database from 2000 to 2018.
• Inclusion of matched pairs: T2DM with/without HTN, HTN with/without T2DM, and comorbid T2DM/HTN.
• Analysis employed Cox proportional-hazard models to assess the risk of cardiovascular events.

Main Results:

• Incident coronary artery disease rates per 1000 person-years were 16.80 for T2DM, 23.18 for HTN, and 31.53 for comorbid cohorts.
• T2DM with subsequent HTN showed significantly higher adjusted hazard ratios (HRs) for coronary artery disease (2.22) and stroke (1.19) compared to T2DM alone.
• HTN with subsequent T2DM also demonstrated increased HRs for coronary artery disease (1.69) and stroke (1.25) compared to HTN alone.

Conclusions:

• Both T2DM with subsequent HTN and HTN with subsequent T2DM are associated with elevated cardiovascular disease risks.
• The findings underscore the compounded risk posed by the co-occurrence and sequential development of T2DM and HTN.
• Integrated management strategies are essential for mitigating cardiovascular risks in patients with diabetes and hypertension.