Patients With Type 2 Diabetes Have Greater Risk of Heart Disease Even With Risk Factors Controlled

New research suggests that preventing cardiovascular disease (CVD) among patients with type 2 diabetes (T2D) should continue to be a priority, even if risk factors associated with heart disease are optimally controlled.

“Previous studies have shown that people with type 2 diabetes had little or no excess risk of cardiovascular disease events or death when all risk factors are optimally controlled,” said first author Alison Wright, PhD, in a statement. “Our team sought to determine how the degree of risk factor control in people with type 2 diabetes impacted CVD risk and mortality compared to people with type 2 diabetes who had all risk factors optimally controlled and to people who do not have type 2 diabetes.”

In the study, investigators analyzed data from between 2006 and 2015 using the Clinical Practice Research Datalink (CPRD) and the Scottish Care Information-Diabetes (SCID) dataset. More than 101,000 people with T2D were identified and matched with nearly 379,000 people without diabetes in the CPRD dataset and nearly 331,000 people with type 2 diabetes in the SCID dataset.

The team focused on 5 risk factors for heart disease, including blood pressure, smoking, cholesterol, triglycerides, and blood glucose, and they examined the association to future cardiovascular events and death among these risk factors that were optimally controlled. The researchers also examined whether the presence of cardiorenal disease impacted these connections.

According to a press release, the findings revealed that only 6% of participants with T2D had all 5 risk factors within target range. Even when all 5 factors were optimally controlled, patients with T2D still had a 21% higher risk for CVD and a 31% higher risk for heart failure hospitalization compared to patients without diabetes. Furthermore, the association among the number of elevated risk factors and CVD event risk was stronger in patients with T2D who did not also have cardiorenal disease.

“People with type 2 diabetes should be treated for cardiovascular risk factors as early as possible, regardless of whether they have cardiovascular disease or not,” Wright said in the press release. “There is real potential here to reduce the overall impact of type 2 diabetes on future cardiovascular events, especially for patients with type 2 diabetes who have not yet been diagnosed with CVD.”

In the press release, the researchers said that although their findings demonstrate the importance of overall risk factor control, future research will explore which individual actors have the greatest impact on cardiovascular risk, and, therefore, are the most important to target with interventions.

REFERENCE

Preventing heart disease should be a priority for people with Type 2 diabetes [news release]. American Heart Association; November 16, 2020. https://newsroom.heart.org/news/preventing-heart-disease-should-be-a-priority-for-people-with-type-2-diabetes. Accessed November 30, 2020.