Diabetes Complications and Comorbidities as Risk Factors for MACE in People With Type 2 Diabetes and Their...

This study aimed to investigate the association between cardiovascular risk factors and major adverse cardiovascular events (MACE) in people with type 2 diabetes, while assessing potential changes over time.

Utilizing data from Danish registries, this study identified people with type 2 diabetes between 2002 and 2021 (n = 372 328) and subdivided them into two 10-year time periods: TP1: 2002-2011 and TP2: 2012-2021, and further categorized into cases and controls. Cases were defined as having suffered a first-time three-point MACE (n_TP1 = 12 713, n_TP2 = 8981) and matched 1:1 with controls on age, sex, and type 2 diabetes duration. Exposures were preselected diabetes complications and comorbidities.

Fewer were affected by MACE during TP2 compared to TP1 (p < 0.001). Diabetes complications associated with MACE were nephropathy (OR_TP1 = 1.54, 95% CI 1.30-1.83, OR_TP2 = 1.47, 95% CI 1.20-1.79), neuropathy (OR_TP1 = 2.02, 95% CI 1.84-2.21 OR_TP2 = 1.58, 95% CI 1.44-1.73) and retinopathy (OR_TP1 = 1.10, 95% CI 0.98-1.23, OR_TP2 = 1.38, 95% CI 1.17-1.63). Comorbidities associated with MACE included hypertension (OR_TP1 = 1.30, 95% CI 1.22-1.38 OR_TP2 = 1.31, 95% CI 1.22-1.41), atrial flutter or fibrillation (OR_TP1 = 1.46, 95% CI 1.35-1.58, OR_TP2 = 1.37, 95% CI 1.26-1.50), heart failure (OR_TP1 = 1.53, 95% CI 1.401.67-, OR_TP2 = 1.37, 95% CI 1.23-1.54) and hypercholesterolemia (OR_TP1 = 1.13, 95% CI 1.07-1.20, OR_TP2 = 1.02, 95% CI 0.96-1.10). Hypercholesterolemia (p = 0.038) and neuropathy (p = 0.038) exhibited a significant decrease in association with MACE between the time periods.

The prevalence of first-time MACE decreased over time, despite a relatively stable prevalence of type 2 diabetes. Several diabetes-related complications and comorbidities were significantly associated with MACE. The associations of neuropathy and hypercholesterolemia with MACE lessened over time, suggesting potential improvements in risk management or treatment strategies.