Higher CVD Risk for Well-managed Type 2 Diabetes Patients

Peter Russell

November 24, 2020

Adults with type 2 diabetes whose condition is well managed have a significantly higher risk of developing cardiovascular disease (CVD) compared to those who do not have diabetes, according to a study.

Research led by the University of Manchester found a 21% higher risk of cardiovascular disease and a 31% higher risk for heart failure hospitalisation for those with type 2 diabetes compared to people in the general population.

The authors said the data supported early and more intensive intervention in patients with type 2 diabetes.

"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 Martin Rutter, professor of cardiometabolic medicine, who co-led the investigation.

Primary Care Records

The study, in the journal Circulation , used data between 2006 and 2015 from the Clinical Practice Research Datalink and the Scottish Care Information-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.

Researchers focused on five cardiovascular risk factors: blood pressure, smoking, cholesterol, triglycerides, and blood glucose. They 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 cardiorenal disease had an impact on these associations.

Among the other main findings were that:

  • Only 6% of people with type 2 diabetes had all five risk factors within target range

  • Each additional risk factor not optimally controlled increased the risk of cardiovascular disease events and mortality

  • The association between the number of elevated risk factors and cardiovascular disease 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 disease prevention

The researchers said it was possible that different metabolic pathways could underlie the development and progression of intimal plaque atheroma seen in people without cardio-renal disease compared with the medial arterial calcification commonly seen in those with cardio-renal disease.

'Potential' to Reduce Risk

Darren Ashcroft, professor of pharmacoepidemiology at Manchester, who co-authored the study, said: "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."

The authors acknowledged that their observational study used primary care records which might not give a complete picture of the health of each patient.

Dr Elizabeth Robertson, director of research at Diabetes UK, which funded the research, said 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".

Risk Factor Control and Cardiovascular Event Risk in People With Type 2 Diabetes in Primary and Secondary Prevention Settings. Published 16 Nov 2020. Circulation. 2020;142:1925–1936. Abstract

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