Alcohol use disorder and cardiovascular risk in type 2 diabetes: beyond alcohol consumption

Alcohol use disorder (AUD) is a chronic neuropsychiatric condition associated with clustering cardiovascular risk factors, yet its independent contribution to incident cardiovascular disease in type 2 diabetes (T2D) remains incompletely defined.

Using the Korean National Health Insurance Service database, we identified 364 950 adults with T2D (AUD, n = 4888 [1.34%]; non-AUD, n = 360 062 [98.66%]) who underwent national health screening in 2012. Incident major adverse cardiovascular events (MACE), defined as a composite of myocardial infarction, ischaemic stroke, and cardiovascular death, were ascertained over a median follow-up of 10.2 years. Associations were evaluated using multivariable Cox proportional hazards models. AUD was independently associated with a higher risk of incident MACE (hazard ratio [HR] 1.70; 95% confidence interval [CI], 1.59-1.82), with the strongest association for cardiovascular death (HR 2.37; 95% CI, 2.06-2.72 Among individuals without AUD, a J-shaped association between alcohol consumption and MACE was observed. In contrast, among those with AUD, cardiovascular risk remained elevated across all levels of alcohol intake (all P < 0.001), including among low-risk drinkers (HR 1.44; 95% CI, 1.30-1.61). The association was most pronounced in middle-aged adults (40-64 years; HR 1.89; 95% CI, 1.75-2.05).

In adults with T2D, AUD was associated with increased risk of incident MACE, even after adjustment for self-reported alcohol consumption volume. These findings suggest that assessment of disordered drinking may complement volume-based alcohol evaluation in cardiovascular risk stratification, although prospective studies are needed to confirm its clinical utility.