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Long-Term Major Adverse Cardiovascular and Cerebrovascular Event Risk in Adult-Onset Type 1 Versus Type 2 Diabetes: A
Anagh Astavans1, Derek Baughman2, Nestoras Mathioudakis3
1The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
European Journal of Preventive Cardiology
|July 10, 2026
Summary
Adult-onset type 1 diabetes (T1DM) patients have lower risks of major adverse cardiovascular and cerebrovascular events (MACCE) and mortality compared to type 2 diabetes (T2DM) patients. However, T2DM patients on antihyperglycemic therapy showed comparable survival rates.
Area of Science:
- Cardiovascular Science
- Endocrinology
- Epidemiology
Background:
- Limited and inconsistent evidence exists on major adverse cardiovascular and cerebrovascular (MACCE) event risk in adult-onset type 1 diabetes (T1DM), especially compared to type 2 diabetes (T2DM).
- Existing data often originates from non-U.S. populations, necessitating research using U.S. patient databases.
Purpose of the Study:
- To compare the long-term risk of MACCE between adult-onset T1DM and T2DM patients.
- To leverage a multi-center U.S. database for robust comparative analysis.
Main Methods:
- Utilized the TriNetX database to identify and follow adult patients diagnosed with T1DM or T2DM between 2005-2015 through 2025.
- Employed 1:1 propensity-score matching based on demographics and comorbidities to create a balanced T2DM comparator cohort.
- Calculated cumulative 10-year risks for MACCE (including stroke, myocardial infarction, heart failure, etc.), kidney complications, and all-cause mortality.
Main Results:
- T1DM patients (n=36,599) were younger and had fewer baseline comorbidities than T2DM patients (n=1,740,748).
- In the matched cohort (n=33,364), T1DM patients exhibited significantly lower 10-year risks of MACCE (5.5% vs. 11.3%) and all-cause mortality (7.7% vs. 8.3%) compared to T2DM patients.
- Antihyperglycemic therapy in T2DM patients mitigated mortality risk, resulting in survival rates comparable to T1DM patients.
Conclusions:
- Adult-onset T1DM is associated with a lower 10-year risk of MACCE and mortality compared to a phenotypically similar T2DM cohort.
- The findings suggest a potentially lower relative cardiovascular event burden in adults newly diagnosed with T1DM.
- Antihyperglycemic treatment in T2DM patients appears to be effective in reducing mortality, achieving survival comparable to T1DM.
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