People With Type 2 Diabetes Have a Greater Risk of Cardiovascular Disease Even With Risk Factors Optimally Controlled

Adults with type 2 diabetes (T2D) have a greater risk of developing cardiovascular disease (CVD) compared with the general population, even when risk factors associated with CVD are optimally controlled, according to research published in the American Heart Association's journal Circulation.

First author Alison Wright, PhD, a research associate at the Centre for Pharmacoepidemiology and Drug Safety at the University of Manchester in the United Kingdom, explained in a press release that previous studies investigating the association between T2D and CVD risk factors had demonstrated that people with T2D had little or no increased risk of CVD events or death when all risk factors are optimally controlled.

"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," Wright said in the press release.

The researchers analyzed data between 2006 and 2015 from the Clinical Practice Research Datalink (CPRD) and the Scottish Care Information-Diabetes (SCI-Diabetes) dataset. After collecting the data, the researchers identified more than 101,000 people with T2D and matched them with approximately 379,000 people without diabetes in CPRD and nearly 331,000 with T2D in SCI-Diabetes.

When conducting the analysis, the researchers focused on 5 risk factors for CVD, including blood pressure, smoking, cholesterol, triglycerides, and blood glucose. They then assessed the association between future CVD events and death with these risk factors when the risk factors are optimally controlled. They also investigated whether the presence of cardiorenal (heart and kidney) disease had any impact on these connections as well.

The results demonstrated that only 6% of participants included in the analysis with T2D had all 5 risk factors within target range. Among patients with these 5 risk factors who had them optimally controlled, those patients with T2D were demonstrated to still have a 21% higher risk for CVD and 31% higher risk for hospitalization from heart failure than people without diabetes.

Additionally, the association between the number of increased risk factors and CVD event risk was greater in people 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."

The researchers noted that although this research showed the importance of controlling all risk factors in patients, future research will investigate the individual risk factors that may have a greater impact on CVD risk and require targeted interventions.

REFERENCE
Preventing heart disease should be a priority for people with Type 2 diabetes. Dallas, TX: American Heart Association; November 16, 2020. eurekalert.org/pub_releases/2020-11/aha-phd111620.php. Accessed November 17, 2020.