Heterogeneous CVD risk demonstrated in people with type 2 diabetes
medwireNews: The 10-year and lifetime cardiovascular disease (CVD) risk of people with type 2 diabetes varies greatly, with the highest risk seen in those with prior CVD, suggests an analysis of data from the CAPTURE study.
As outlined at the virtual 57th EASD Annual Meeting, Jan Westerink (University Medical Center Utrecht, the Netherlands) and colleagues used the DIAL competing risk-adjusted model to predict long-term CVD risk using individual-level data from CAPTURE, a cross-sectional study of 9823 adults with type 2 diabetes from 13 countries across five continents in 2019.
Westerink reported a wide distribution in predicted 10-year CVD risk, showing that some people with type 2 diabetes have “very much higher risk than others.” For the 2901 people with prior CVD, the average risk was 40%, ranging from approximately 10% to 70%, and “almost all” (96%) of these individuals had a high 10-year CVD risk (>10%), he added.
The 10-year risk also varied among the 6515 individuals without prior CVD, at an average of 5%, and ranging from around 0% to 20%. Just 14% of these people had a high 10-year risk.
There was a similar pattern of results for predicted lifetime CVD risk, with an average risk of 65% for people with prior CVD and 10% for those without; the corresponding proportions of people with high lifetime risk (>50%) were 80% and 0.4%.
Westerink said that the use of sodium-glucose cotransporter (SGLT)2 inhibitors and glucagon-like peptide (GLP)-1 receptor agonists “does not seem to be dependent on lifetime risk” in people with or without a history of CVD, indicating that “we’re currently not treating the patients with the highest risk.” Indeed, a comparable proportion of patients with and without prior CVD were taking SGLT2 inhibitors (18 vs 16%) and GLP-1 receptor agonists (10 vs 11%).
The presenter also noted “marked regional differences” in the use of these drugs. In people with prior CVD, the highest rates of SGLT2 inhibitor use were in the Middle East and the highest rates of GLP-1 receptor agonist use were in the Middle East and Western Europe. The highest rates of use for these agents in people without prior CVD were seen in Australia and Western Europe, respectively.
Westerink concluded that “shared decision-making in the clinical setting can be greatly enhanced by discussing with patients their predicted 10-year and especially lifetime CVD risks, as well as estimated cardiovascular benefits to be gained from preventive intervention.”
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