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Clinical cardiovascular phenotypes and the pattern of future events in patients with type 2 diabetes

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Abstract

Importance

Updated guidelines on diabetes recommend targeting sodium–glucose cotransporter-2 inhibitors (SGLT2i) at patients at risk of heart failure (HF) and glucagon-like peptide-1 receptor agonists (GLP1-RA) at those at greater risk of atherothrombotic events.

Objective

We estimated the risk of different cardiovascular events in patients with type 2 diabetes (T2D) and newly established cardiovascular disease.

Design, setting and participants

Patients with T2D and newly established cardiovascular disease from 1998 to 2016 were identified using Danish healthcare registers and divided into one of four phenotype groups: (1) HF, (2) ischemic heart disease (IHD), (3) transient ischemic stroke (TIA)/ischemic stroke, and (4) peripheral artery disease (PAD). The absolute 5-year risk of the first HF- or atherothrombotic event occurring after inclusion was calculated, along with the risk of death.

Main outcomes and measures

The main outcome was the first event of either HF or an atherothrombotic event (IHD, TIA/ischemic stroke or PAD) in patients with T2D and  new-onset cardiovascular disease.

Results

Of the 37,850 patients included, 40% were female and the median age was 70 years. Patients with HF were at higher 5-year risk of a subsequent HF event (17.9%; 95% confidence interval (CI) 17.1–18.8%) than an atherothrombotic event (15.8%; 15.0–16.6%). Patients with IHD were at higher risk of a subsequent atherothrombotic event (24.6%; 23.9–25.3%) than developing HF, although the risk of HF was still substantial (10.6%; 10.2–11.1%). Conversely, patients with PAD were at low risk of developing HF (4.4%; 3.8–5.1%) but at high risk of developing an atherothrombotic event (15.9%; 14.9–17.1%). Patients with TIA/ischemic stroke had the lowest risk of HF (3.2%; 2.9–3.6%) and the highest risk of an atherothrombotic event (20.6%; 19.8–21.4).

Conclusions

In T2D, a patient’s cardiovascular phenotype can help predict the pattern of future cardiovascular events.

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Abbreviations

T2D:

Type 2 diabetes

SGLT2i:

Sodium–glucose cotransporter-2 inhibitors

HF:

Heart failure

GLP1-RA:

Glucagon-like peptide-1 receptor agonists

IHD:

Ischemic heart disease

TIA:

Transient ischemic stroke

PAD:

Peripheral artery disease

ATC:

Anatomical therapeutic chemical system

CI:

Confidence interval

ICD:

International Classification of Diseases

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Funding

Mariam Elmegaard Malik was funded by a research grant from Department of Cardiology, Herlev and Gentofte Hospital.

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Authors and Affiliations

  1. Department of Cardiology, Herlev and Gentofte University Hospital, Cardiovascular Research Unit 1-Post 635, Gentofte Hospitalsvej 1, 2900, Hellerup, Denmark

    Mariam Elmegaard Malik, Paul Blanche, Maria D’Souza, Christian Madelaire, Bochra Zareini, Morten Lamberts, Gunnar Gislason & Morten Schou

  2. Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA

    Charlotte Andersson

  3. Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark

    Paul Blanche

  4. The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Søren Lund Kristensen & Lars Køber

  5. BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK

    Naveed Sattar & John McMurray

  6. Department of Research, Nordsjællands Hospital, Hillerød, Denmark

    Christian Torp-Pedersen

  7. Danish Heart Foundation, Copenhagen, Denmark

    Christian Torp-Pedersen & Gunnar Gislason

Authors
  1. Mariam Elmegaard Malik
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  2. Charlotte Andersson
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Correspondence to Mariam Elmegaard Malik.

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Malik, M.E., Andersson, C., Blanche, P. et al. Clinical cardiovascular phenotypes and the pattern of future events in patients with type 2 diabetes. Clin Res Cardiol 112, 215–226 (2023). https://doi.org/10.1007/s00392-022-02016-z

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  • DOI: https://doi.org/10.1007/s00392-022-02016-z

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