medwireNews: Four in five people with type 2 diabetes will have a major cardiovascular or renal disease (CVRD) event in their lifetime, and around half will develop chronic kidney disease, report researchers.
“[T]he majority of clinical and public health efforts rest on short-term risk, and even in prevention, 10 years is the maximum window over which risk is estimated and conveyed to patients,” say Amitava Banerjee (University College London, UK) and study co-authors.
Given their findings, including that almost all people with one diagnosed cardiorenal comorbidity will go on to have another event, they argue that this focus underestimates the total burden of cardiorenal disease in people with type 2 diabetes.
The team used data from 473,399 people with type 2 diabetes identified in English primary care, hospital admission, and mortality databases. Among the 276,941 without CVRD at baseline, at the age of 45 years, the lifetime risk for hospitalization or death due to CVRD was 80.0%, the risk for chronic kidney disease was 53.6%, and the risk for dying from CV disease was 40.5%.
The CVRD risk declined with increasing age because of competing risks, but remained high even at the age of 85 years, the researchers report in BMC Medicine.
And the lifetime CVRD risk was even higher in people who already had heart failure, chronic kidney disease, myocardial infarction, stroke, or peripheral artery disease, ranging from 89.2% to 97.6% depending on the baseline comorbidity.
These baseline comorbidities accounted for a large proportion of the CVRD risk in those people exposed to them, ranging from 51.5% for stroke to 74.8% for heart failure. However, other risk factors also played a part. For example, severe obesity accounted for 28.7% of the risk, current smoking for 11.7%, and physical inactivity for 50.6% in exposed people.
Indeed, Banerjee and team calculated that, among exposed individuals, 41.9% of the CVRD risk was attributable to having one or more of obesity, current smoking, glycated hemoglobin of at least 7% (53 mmol/mol), hypertension, hypercholesterolemia, or being physically inactive.
These factors accounted for a similar proportion of risk (41.5%) in people with type 2 diabetes overall, whereas the individual comorbidities each accounted for less than 5% due to being less common.
“Improved secondary prevention is a major opportunity to reduce healthcare costs to patients and health systems,” say the researchers.
Noting the high lifetime risk even in people free of CVRD, they hope that their results “may change the misperception of the risk status in the younger [type 2 diabetes] population and inform change in national guidelines for diabetes and cardiorenal risk management in these individuals.”
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