Gap in cardiovascular risk not closing for people with type 2 diabetes
medwireNews: The incidence of coronary heart disease (CHD) has declined in recent years but people with type 2 diabetes continue to have a significantly greater risk than those without, Scottish data show.
Stephanie Read (University of Edinburgh, UK) and co-investigators believe their findings provide “a strong argument for the further intensification of cardiovascular disease risk factor management in people with type 2 diabetes.”
Between 2006 and 2015, during 34.9 million person–years of follow-up, there were 129,926 acute myocardial infarction (AMI) events, 41,263 hospital admissions for angina, and 69,875 coronary revascularization procedures recorded in Scotland.
After adjusting for age and deprivation level, the overall incidence of AMI, hospitalization for angina, and revascularization procedures declined by an average 2.00%, 9.62%, and 0.35% per year, respectively, during the study period.
The researchers found that the rates of decline were similar for individuals with and without diabetes, meaning that the excess risk for CHD previously observed among people with type 2 diabetes has not changed over time.
Specifically, the risk for AMI was a significant 1.86-fold higher for men with diabetes and 2.32-fold higher for women with diabetes than for men and women without diabetes, respectively.
And similar patterns were observed for angina and coronary revascularization.
“This suggests that changes in diagnostic practice, measures to address cardiovascular risk factors and introduction of new treatments for diabetes in recent years have not had a discernible differential effect in people with type 2 diabetes compared with people without diabetes,” Read and co-authors write in Diabetologia.
The investigators also found that case-fatality rates among the 77,211 people admitted to hospital with a first AMI were higher in people with type 2 diabetes than in people without (13.0 vs 9.5%) but declined at the same average rate (7.93% per year) in both groups.
Read and team note that they could not adjust their findings for potentially important confounders such as cardiovascular disease (CVD) risk factors because the information was not available.
They were therefore “unable to determine how risk factor patterns had changed over time or to what extent differences in risk factors contributed to the disparity in AMI incidence between people with type 2 diabetes and people without diabetes.”
“Given that diabetes is associated with worse CVD risk factor profiles, it is fair to assume that the excess risk of CHD observed in this study was in part due to differences in the distribution of CVD risk factors between the groups,” the researchers remark.
They conclude that their findings “have important implications for primary and secondary prevention of CHD in the future, given the growing prevalence of type 2 diabetes and an ageing population.”
By Laura Cowen
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