Unexplained Residual Risk In Type 2 Diabetes: How Big Is The Problem?

Area of Science:

• Cardiology
• Endocrinology
• Public Health

Background:

• Cardiovascular disease (CVD) is the primary cause of death in individuals with type 2 diabetes (T2D).
• Less than 10% of T2D patients achieve recommended therapy goals for major CVD risk factors.
• Understanding unexplained cardiovascular risk in T2D is critical for improving patient outcomes.

Purpose of the Study:

• To evaluate the proportion of absolute cardiovascular (CV) risk in T2D patients explained by major CV intervention trials.
• To identify gaps in current understanding of CV risk reduction in T2D.
• To explore potential reasons for unexplained CV risk.

Main Methods:

• Review of multiple long-term cardiovascular intervention trials focusing on target-directed therapies.
• Analysis of the STENO-2 trial, a prospective multifactorial intervention study.
• Calculation of cumulative absolute CV risk reduction from reviewed trials.

Main Results:

• Major CV intervention trials have shown varying effects on major adverse cardiovascular events (MACE).
• The STENO-2 trial demonstrated a 20% absolute CV risk reduction through intensified multifactorial intervention.
• A significant 44.1% of absolute CV risk in T2D remains unexplained after aggregating trial data.

Conclusions:

• Synergistic interactions between major CV risk factors may account for unexplained risk in T2D.
• Simultaneous management of all major CV risk factors to guideline goals is essential for maximal CV risk reduction.
• Further research is needed to elucidate and address the remaining unexplained CV risk in T2D patients.