Cardiovascular Risk Starts Early: T2DM Linked to Two-Fold More CVD Events Decades Before Diagnosis, Study Reveals

The relationship between type 2 diabetes mellitus and an increased risk of CVD is well-established. Still, the timeline for when CVD events begin to occur relative to T2DM diagnosis has remained unclear. In this context, Christine Gyldenkerne, Aarhus University Hospital, Denmark, and colleagues sought to explore the incidence of CVD events up to 30 years before and 5 years after a T2DM diagnosis, comparing individuals diagnosed with the disease to matched individuals from the general population. This study aimed to clarify how far in advance the elevated risk for cardiovascular issues emerges in those who eventually develop T2DM.

For this purpose, the researchers conducted a combined case-control and cohort study, which included all individuals diagnosed with type 2 diabetes mellitus in Denmark between 2010 and 2015, alongside age- and sex-matched comparisons from the general population. Cardiovascular disease was defined as either myocardial infarction or ischemic stroke.

To assess the prevalence of CVD over 30 years before the diagnosis of T2DM, conditional logistic regression was used to calculate odds ratios (ORs). For the incidence of CVD in the five years following T2DM diagnosis, Cox proportional hazard regression models were applied to compute hazard ratios (HRs).

The study findings are as follows:

• The study involved 127,092 individuals diagnosed with type 2 diabetes mellitus (T2DM) and 381,023 matched comparisons from the general population.
• Over 30 years before T2DM diagnosis, 11.2% of individuals with T2DM and 4.7% comparisons experienced cardiovascular disease (CVD).
• CVD prevalence was consistently higher in those with T2DM compared to the matched comparisons throughout the entire 30-year period before diagnosis.
• Odds ratios (ORs) for CVD prevalence ranged from 2.18 in the period 25–30 years before diagnosis to 2.96 in the final years (<5 years before diagnosis).
• In the five years following T2DM diagnosis, the incidence of CVD was similarly elevated in individuals with T2DM, with a hazard ratio (HR) of 2.20 compared to the general population.

"The findings showed that individuals with type 2 diabetes mellitus experienced twice the number of cardiovascular disease events compared to matched individuals, beginning as far back as 30 years before their T2DM diagnosis. This suggests that preventive strategies could be implemented much earlier in individuals at risk for T2DM," the researchers concluded.

Reference:

Gyldenkerne C, Kahlert J, Thrane PG, et al. 2-fold more cardiovascular disease events decades before type 2 diabetes diagnosis: a nationwide registry study. J Am Coll Cardiol. 2024;84:2251-2259.