Well-managed type 2 diabetes patients have 21% higher risk of cardiovascular disease

Well managed adults with type 2 diabetes have a 21% higher risk of developing cardiovascular disease (CVD) compared to the general population, according to new research.

The research from The University of Manchester, led by Professor Martin Rutter and Professor Darren Ashcroft, in collaboration with the University of Edinburgh, is published in the journal Circulation and was supported by Diabetes UK.

“People with type 2 diabetes should attempt to lead healthy lifestyles and be treated for cardiovascular risk factors as early as possible, regardless of whether they have cardiovascular disease or not,” said co-senior author Professor Martin Rutter.

Co-senior author Professor Darren Ashcroft added: “There is real potential here to reduce the overall impact of type 2 diabetes on future cardiovascular events, especially in patients with type 2 diabetes who have not yet been diagnosed with CVD.”

Dr Alison Wright based at the University’s Centre for Pharmacoepidemiology and Drug Safety, and first author for this study, said: “A Swedish study has suggested that people with type 2 diabetes had little or no excess risk of cardiovascular disease events or death when all risk factors are optimally controlled.

Professor Sarah Wild, co-senior author from the University of Edinburgh, added: “Our team sought to determine how the degree of risk factor control in people in the UK with type 2 diabetes affects 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.”

The research team analysed data between 2006 and 2015 from the Clinical Practice Research Datalink (CPRD) and the Scottish Care Information-Diabetes (SCI-Diabetes) dataset. More than 101,000 people with type 2 diabetes were matched with nearly 379,000 people without diabetes in England, with a further 331,000 with type 2 diabetes from Scotland.

They focused on five cardiovascular risk factors: blood pressure, smoking, cholesterol, triglycerides and blood glucose and examined the association between the number of these risk factors which were optimally controlled on future cardiovascular events and death. They also examined if the presence of heart and kidney disease (cardiorenal disease) impacted these connections.

Their analysis found:

  • Only 6% of people with type 2 diabetes had all five risk factors within target range.
  • Even when all five cardiovascular risk factors were optimally controlled, people with type 2 diabetes still had a 21% higher risk for CVD and 31% higher risk for heart failure hospitalization than people without diabetes.
  • For each additional risk factor not optimally controlled, the risk of CVD events and mortality increased.
  • The association between the number of elevated risk factors and CVD events and mortality was stronger in people with type 2 diabetes who did not have cardiorenal disease than in those with cardiorenal disease.
  • Patients with diabetes and no history of impaired kidney function were more likely to be younger and use fewer medications for cardiovascular prevention.

Dr Elizabeth Robertson, Director of Research at Diabetes UK, said: “This research, funded by Diabetes UK, shows that although having type 2 diabetes adds to the risk of developing heart disease, by keeping blood sugars, blood pressure and blood fats in a healthy range, and having a healthy lifestyle – you can minimise that risk.

“It is also an important reminder that people with type 2 diabetes should not delay taking steps to prevent heart disease. Stopping smoking, eating a healthy, balanced diet and being physically active are all ways you can improve your heart health and this research reinforces how essential it is for people with diabetes to get the right care, at the right time to be able to reduce their risk of heart disease effectively. To find out ways to stay healthy and active, visit Diabetes UK’s website.”

As the research is an observational study, it uses data from primary care medical records that may be incomplete so it may not provide the full picture of the health status for these patients.

The paper ‘Risk factor control and cardiovascular event risk in people with type 2 diabetes in primary and secondary prevention settings’ is publuished in Circulation

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