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Cardiovascular Outcomes in Individuals With Diabetes, Coronary Heart Disease, or Both: A Population-Based Cohort
Kevin K W Olesen1, Christine Gyldenkerne1, Pernille G Thrane1
1Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
Insights
In contemporary cohorts, diabetes alone presents a lower cardiovascular risk than coronary heart disease (CHD) alone. However, diabetes increases non-coronary vascular events and all-cause mortality, highlighting its significant long-term health impact.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Historically, diabetes conferred cardiovascular risk comparable to prior myocardial infarction.
- The advent of statins introduced new primary preventive strategies.
- Contemporary risk stratification for diabetes and coronary heart disease (CHD) requires re-evaluation.
Purpose of the Study:
- To compare the cardiovascular risk associated with diabetes alone versus CHD alone in a contemporary population.
- To assess the impact of these conditions on major adverse cardiovascular events, coronary events, non-coronary vascular events, and all-cause mortality.
Main Methods:
- A cohort of 1,116,456 individuals aged 50-89 in Western Denmark (January 1, 2012) was analyzed.
- Participants were categorized into four groups: diabetes alone, CHD alone, both, or neither.
- Follow-up was conducted for up to seven years to record cardiovascular outcomes.
Main Results:
- Diabetes alone showed lower seven-year rates of MACE (10.8% vs. 19.7%) and coronary events (6.1% vs. 16.0%) compared to CHD alone.
- Diabetes alone was associated with higher rates of non-coronary vascular events (9.4% vs. 9.9%) and all-cause mortality (25.6% vs. 30.6%).
Conclusions:
- Diabetes alone does not present the same level of coronary or cardiovascular risk as CHD alone in the contemporary era.
- Diabetes is linked to increased risks of non-coronary vascular events and all-cause mortality, necessitating targeted preventive strategies.
Background:
In the pre-statin era, diabetes posed a similar cardiovascular risk as previous myocardial infarction in patients without diabetes. Since the development of statins, several primary preventive treatment strategies have been introduced. We investigated whether diabetes and coronary heart disease (CHD) confer similarly high cardiovascular risk in a semi-nationwide contemporary cohort.
Methods:
We included all individuals aged 50-89 residing in Western Denmark on January 1, 2012. Participants were categorized into four groups: diabetes alone, CHD alone, both diabetes and CHD, and neither condition. CHD was defined as previous myocardial infarction, coronary revascularization, or documented coronary artery disease. Participants were followed for up to seven years for major adverse cardiovascular events (MACE), coronary events (myocardial infarction, percutaneous coronary intervention, or coronary artery bypass grafting), non-coronary vascular events (ischemic stroke, lower limb revascularization, or amputation), and all-cause mortality.
Findings:
We included 1,116,456 people residing in Western Denmark on January 1, 2012. Of these, 7.5% (84,186/1,116,456) had diabetes alone; 5.0% (55,072/1,116,456) had CHD alone. Diabetes alone, compared with CHD alone, was associated with lower seven-year rates of MACE (10.8% versus 19.7%, adjusted hazard ratio (HR) 0.77, 95% CI 0.74-0.78) and coronary events (6.1% versus 16.0%, adjusted HR 0.46, 95% CI 0.44-0.48), but higher rates of non-coronary vascular events (9.4% versus 9.9%, adjusted HR 1.27, 95% CI 1.22-1.32) and all-cause mortality (25.6% versus 30.6%, adjusted HR 1.31, 95% CI 1.28-1.33).
Interpretation:
Diabetes alone does not carry the same coronary or cardiovascular risk as CHD alone, but it is associated with increased rates of non-coronary vascular events and all-cause mortality.
Funding:
This study was funded by the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
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