Twenty Years of Cardiovascular Complications and Risk Factors in Patients With Type 2 Diabetes: A Nationwide Swedish Cohort Study
Authors' conclusion
Risk and rates for atherosclerotic complications and HF are generally decreasing among individuals with T2D, although HF incidence has notably plateaued in recent years. Modifiable risk factors within target levels were associated with lower risks for outcomes. This was particularly notable for systolic blood pressure and glycated hemoglobin for atherosclerotic outcomes and body mass index for heart failure.
Study context
- Population
- Individuals with T2D and matched control subjects, Sweden, 2001–2019
- Participants
- 679,072 vs 2,643,800
- Exposure
- T2D vs matched control subjects; trends 2001–2019
- T2Dn = 679,072
- Controln = 2,643,800reference
- Outcome
- Trends in incident CAD, acute MI, cerebrovascular disease and HF (time to first event)
- Follow-up
- 2001–2019
Methodological detailsregistry-based, matched control subjects
- Registry-based
- Matched control subjects
Main finding
As reported in the abstract
Incidence rates per 10 000 person-years in T2D, 2001 vs 2019
| Group | Acute MI 2001 | Acute MI 2019 | CAD 2001 | CAD 2019 | Cerebrovascular disease 2001 | Cerebrovascular disease 2019 | Heart failure (HF) 2001 | HF 2019 |
|---|---|---|---|---|---|---|---|---|
| T2D | 73.9 (95% CI, 65.4-86.8) | 41.0 (95% CI, 39.5-42.6) | 205.1 (95% CI, 186.8-227.5) | 80.2 (95% CI, 78.2-82.3) | 83.9 (95% CI, 73.6-98.5) | 46.2 (95% CI, 44.9-47.6) | 98.3 (95% CI, 89.4-112.0) | 75.9 (95% CI, 74.4-77.5) |
T2D
Acute MI 200173.9 (95% CI, 65.4-86.8)
Acute MI 201941.0 (95% CI, 39.5-42.6)
CAD 2001205.1 (95% CI, 186.8-227.5)
CAD 201980.2 (95% CI, 78.2-82.3)
Cerebrovascular disease 200183.9 (95% CI, 73.6-98.5)
Cerebrovascular disease 201946.2 (95% CI, 44.9-47.6)
Heart failure (HF) 200198.3 (95% CI, 89.4-112.0)
HF 201975.9 (95% CI, 74.4-77.5)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| HF, T2D with no risk factor beyond targetvs control subjectsNo risk factor above target | 1.50 (1.35–1.67) | |
| 0.512Hazard ratio (log scale) |
HF, T2D with no risk factor beyond target vs control subjects
- No excess CV risk vs control subjects for other outcomes when no risk factor beyond target
Risk factors and outcomes in T2D
- BMI alone potentially explained share of HF risk
- >30%
- Glycated hemoglobin, SBP, eGFR and lipids independently associated with outcomes
- CAD and cerebrovascular disease risk increased stepwise for each risk factor not within target
- Glycated hemoglobin most prognostically important for atherosclerotic events; BMI for HF
Original publication
Twenty Years of Cardiovascular Complications and Risk Factors in Patients With Type 2 Diabetes: A Nationwide Swedish Cohort Study. Circulation. Published 8 May 2023. doi:10.
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