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Updated: Sep 27, 2025
Modeling and Evaluation of Murine Diabetic Cardiomyopathy Model
Published on: November 29, 2024
Clinical cardiovascular phenotypes and the pattern of future events in patients with type 2 diabetes
Mariam Elmegaard Malik1, Charlotte Andersson2, Paul Blanche3,4
1Department of Cardiology, Herlev and Gentofte University Hospital, Cardiovascular Research Unit 1-Post 635, Gentofte Hospitalsvej 1, 2900, Hellerup, Denmark. mariam.elmegaard.malik@regionh.dk.
Importance:
Updated guidelines on diabetes recommend targeting sodium-glucose cotransporter-2 inhibitors (SGLT2i) at patients at risk of heart failure (HF) and glucagon-like peptide-1 receptor agonists (GLP1-RA) at those at greater risk of atherothrombotic events.
Objective:
We estimated the risk of different cardiovascular events in patients with type 2 diabetes (T2D) and newly established cardiovascular disease.
Design, Setting And Participants:
Patients with T2D and newly established cardiovascular disease from 1998 to 2016 were identified using Danish healthcare registers and divided into one of four phenotype groups: (1) HF, (2) ischemic heart disease (IHD), (3) transient ischemic stroke (TIA)/ischemic stroke, and (4) peripheral artery disease (PAD). The absolute 5-year risk of the first HF- or atherothrombotic event occurring after inclusion was calculated, along with the risk of death.
Main Outcomes And Measures:
The main outcome was the first event of either HF or an atherothrombotic event (IHD, TIA/ischemic stroke or PAD) in patients with T2D and new-onset cardiovascular disease.
Results:
Of the 37,850 patients included, 40% were female and the median age was 70 years. Patients with HF were at higher 5-year risk of a subsequent HF event (17.9%; 95% confidence interval (CI) 17.1-18.8%) than an atherothrombotic event (15.8%; 15.0-16.6%). Patients with IHD were at higher risk of a subsequent atherothrombotic event (24.6%; 23.9-25.3%) than developing HF, although the risk of HF was still substantial (10.6%; 10.2-11.1%). Conversely, patients with PAD were at low risk of developing HF (4.4%; 3.8-5.1%) but at high risk of developing an atherothrombotic event (15.9%; 14.9-17.1%). Patients with TIA/ischemic stroke had the lowest risk of HF (3.2%; 2.9-3.6%) and the highest risk of an atherothrombotic event (20.6%; 19.8-21.4).
Conclusions:
In T2D, a patient's cardiovascular phenotype can help predict the pattern of future cardiovascular events.
Insights
Patients with type 2 diabetes (T2D) and cardiovascular disease have varying risks for future heart failure (HF) or atherothrombotic events. Understanding a patient's specific cardiovascular phenotype is key to predicting their risk pattern.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Updated guidelines recommend SGLT2i for heart failure risk and GLP1-RA for atherothrombotic risk in type 2 diabetes (T2D).
- Risk stratification is crucial for optimizing cardiovascular event prevention in T2D patients with established cardiovascular disease.
Purpose of the Study:
- To estimate the risk of different cardiovascular events in patients with T2D and newly diagnosed cardiovascular disease.
- To analyze the 5-year risk of heart failure (HF) or atherothrombotic events based on initial cardiovascular phenotype.
Main Methods:
- Danish healthcare registers identified 37,850 patients with T2D and new-onset cardiovascular disease (1998-2016).
- Patients were categorized into four phenotypes: HF, ischemic heart disease (IHD), transient ischemic stroke (TIA)/ischemic stroke, or peripheral artery disease (PAD).
- Absolute 5-year risks of subsequent HF, atherothrombotic events, and death were calculated.
Main Results:
- Patients initially diagnosed with HF had a higher risk of subsequent HF (17.9%) than atherothrombotic events (15.8%).
- Those with IHD faced a higher risk of atherothrombotic events (24.6%) but a substantial risk of HF (10.6%).
- PAD patients had a low HF risk (4.4%) but high atherothrombotic risk (15.9%), while TIA/stroke patients had the lowest HF risk (3.2%) and highest atherothrombotic risk (20.6%).
Conclusions:
- A patient's cardiovascular phenotype in type 2 diabetes (T2D) significantly predicts the pattern of future cardiovascular events.
- This phenotype-based risk assessment can inform targeted preventive strategies, such as SGLT2i or GLP1-RA use.
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