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Lancet Diabetes Endocrinol. 2015 Feb;3(2):105-13. doi: 10.1016/S2213-8587(14)70219-0. Epub 2014 Nov 11.

Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1·9 million people.

Author information

1
Farr Institute of Health Informatics Research at London, London, UK; Department of Epidemiology and Public Health, University College London, London, UK. Electronic address: anoop@doctors.org.uk.
2
Department of Epidemiology and Public Health, University College London, London, UK; MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
3
Farr Institute of Health Informatics Research at London, London, UK; Department of Epidemiology and Public Health, University College London, London, UK.
4
Faculty of Medicine and Health, University of Leeds, Leeds, UK.
5
Farr Institute of Health Informatics Research at London, London, UK; National Institute of Cardiovascular Outcomes Research, University College London, London, UK.
6
Farr Institute of Health Informatics Research at London, London, UK; Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
7
Farr Institute of Health Informatics Research at London, London, UK; Barts and the London National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary, University of London, London, UK.

Abstract

BACKGROUND:

The contemporary associations of type 2 diabetes with a wide range of incident cardiovascular diseases have not been compared. We aimed to study associations between type 2 diabetes and 12 initial manifestations of cardiovascular disease.

METHODS:

We used linked primary care, hospital admission, disease registry, and death certificate records from the CALIBER programme, which links data for people in England recorded in four electronic health data sources. We included people who were (or turned) 30 years or older between Jan 1, 1998, to March 25, 2010, who were free from cardiovascular disease at baseline. The primary endpoint was the first record of one of 12 cardiovascular presentations in any of the data sources. We compared cumulative incidence curves for the initial presentation of cardiovascular disease and used Cox models to estimate cause-specific hazard ratios (HRs). This study is registered at ClinicalTrials.gov (NCT01804439).

FINDINGS:

Our cohort consisted of 1 921 260 individuals, of whom 1 887 062 (98·2%) did not have diabetes and 34 198 (1·8%) had type 2 diabetes. We observed 113 638 first presentations of cardiovascular disease during a median follow-up of 5·5 years (IQR 2·1-10·1). Of people with type 2 diabetes, 6137 (17·9%) had a first cardiovascular presentation, the most common of which were peripheral arterial disease (reported in 992 [16·2%] of 6137 patients) and heart failure (866 [14·1%] of 6137 patients). Type 2 diabetes was positively associated with peripheral arterial disease (adjusted HR 2·98 [95% CI 2·76-3·22]), ischaemic stroke (1·72 [1·52-1·95]), stable angina (1·62 [1·49-1·77]), heart failure (1·56 [1·45-1·69]), and non-fatal myocardial infarction (1·54 [1·42-1·67]), but was inversely associated with abdominal aortic aneurysm (0·46 [0·35-0·59]) and subarachnoid haemorrhage (0·48 [0·26-0.89]), and not associated with arrhythmia or sudden cardiac death (0·95 [0·76-1·19]).

INTERPRETATION:

Heart failure and peripheral arterial disease are the most common initial manifestations of cardiovascular disease in type 2 diabetes. The differences between relative risks of different cardiovascular diseases in patients with type 2 diabetes have implications for clinical risk assessment and trial design.

FUNDING:

Wellcome Trust, National Institute for Health Research, and Medical Research Council.

Comment in

PMID:
25466521
PMCID:
PMC4303913
DOI:
10.1016/S2213-8587(14)70219-0
[Indexed for MEDLINE]
Free PMC Article

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