Clinical cardiovascular phenotypes and the pattern of future events in patients with type 2 diabetes

Malik, M. E. et al. (2023) Clinical cardiovascular phenotypes and the pattern of future events in patients with type 2 diabetes. Clinical Research in Cardiology, 112(2), pp. 215-226. (doi: 10.1007/s00392-022-02016-z) (PMID:35396632)

Abstract

Importance: Updated guidelines on diabetes recommend targeting sodium–glucose cotransporter-2 inhibitors (SGLT2i) at patients at risk of heart failure (HF) and glucagon-like peptide-1 receptor agonists (GLP1-RA) at those at greater risk of atherothrombotic events. Objective: We estimated the risk of different cardiovascular events in patients with type 2 diabetes (T2D) and newly established cardiovascular disease. Design, setting and participants: Patients with T2D and newly established cardiovascular disease from 1998 to 2016 were identified using Danish healthcare registers and divided into one of four phenotype groups: (1) HF, (2) ischemic heart disease (IHD), (3) transient ischemic stroke (TIA)/ischemic stroke, and (4) peripheral artery disease (PAD). The absolute 5-year risk of the first HF- or atherothrombotic event occurring after inclusion was calculated, along with the risk of death. Main outcomes and measures: The main outcome was the first event of either HF or an atherothrombotic event (IHD, TIA/ischemic stroke or PAD) in patients with T2D and new-onset cardiovascular disease. Results: Of the 37,850 patients included, 40% were female and the median age was 70 years. Patients with HF were at higher 5-year risk of a subsequent HF event (17.9%; 95% confidence interval (CI) 17.1–18.8%) than an atherothrombotic event (15.8%; 15.0–16.6%). Patients with IHD were at higher risk of a subsequent atherothrombotic event (24.6%; 23.9–25.3%) than developing HF, although the risk of HF was still substantial (10.6%; 10.2–11.1%). Conversely, patients with PAD were at low risk of developing HF (4.4%; 3.8–5.1%) but at high risk of developing an atherothrombotic event (15.9%; 14.9–17.1%). Patients with TIA/ischemic stroke had the lowest risk of HF (3.2%; 2.9–3.6%) and the highest risk of an atherothrombotic event (20.6%; 19.8–21.4). Conclusions: In T2D, a patient’s cardiovascular phenotype can help predict the pattern of future cardiovascular events.

• Item Type: Articles
• Additional Information: Mariam Elmegaard Malik was funded by a research grant from Department of Cardiology, Herlev and Gentofte Hospital.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Sattar, Professor Naveed and Kober, Professor Lars and McMurray, Professor John
• Authors: Malik, M. E., Andersson, C., Blanche, P., D’Souza, M., Madelaire, C., Zareini, B., Lamberts, M., Kristensen, S. L., Sattar, N., McMurray, J., Køber, L., Torp-Pedersen, C., Gislason, G., and Schou, M.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Clinical Research in Cardiology
• Publisher: Springer
• ISSN: 1861-0684
• ISSN (Online): 1861-0692
• Published Online: 08 April 2022