Cardiovascular risk associated with intellectual disability among adults with type 2 diabetes: a nationwide cohort...

Individuals with intellectual disability (ID) are at elevated risk for cardiovascular disease (CVD), a vulnerability compounded by coexisting type 2 diabetes (T2D). We evaluated the extent to which ID is associated with incident CVD by directly comparing ID with both non-ID disabilities and no disabilities.

We conducted a nationwide, population-based cohort study of adults with T2D (aged ≥20 years) in South Korea, with health screenings between January 1, 2015, and December 31, 2016, and follow-up until December 31, 2022 (median 5.9 years). Individuals with a prior myocardial infarction (MI) or ischemic stroke, missing covariates, or a cardiovascular event within the first year of follow-up were excluded. Disability was classified as ID, non-ID disabilities, or no disabilities using the Korea National Disability Registration System. The primary outcome was incident CVD, defined as MI (ICD-10: I21-22) or ischemic stroke (ICD-10: I63-64), assessed throughout follow-up. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards models.

Of 2,062,821 adults with T2D, 4574 (0.22%) had ID, 173,350 (8.4%) had non-ID disabilities, and 1,884,897 (91.4%) had no disabilities, and 111,450 incident CVD events were recorded during follow-up. The ID group had the highest CVD risk compared to those with no disabilities (HR 1.72; 95% CI 1.52-1.94), substantially exceeding non-ID disabilities (HR 1.35; 95% CI 1.33-1.37; P < .001). This vulnerability was most pronounced for ischemic stroke (HR 1.91; 95% CI 1.62-2.25), and remained evident even in mild ID (HR 1.61; 95% CI 1.36-1.91).

ID is associated with a substantially greater CVD risk burden in adults with T2D than other disabilities, particularly for ischemic stroke. Future studies are needed to evaluate long-term cardiovascular trajectory and targeted prevention strategies in this population.

This study was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (K.H.; NRF-2023S1A5A2A21083821). This research was also supported by the GLAMP Program of the National Research Foundation of Korea (NRF) grant funded by the Ministry of Education (No. RS-2025-25441317).