Shah, AD;
Langenberg, C;
Rapsomaniki, E;
Denaxas, S;
Pujades Rodriguez, M;
Gale, CP;
Deanfield, J;
... Hemingway, H; + view all
(2015)
Type 2 diabetes and incidence of a wide range of cardiovascular diseases: a cohort study in 1-9 million people.
Lancet Diabetes and Endocrinology
, 3
(2)
pp. 105-113.
10.1016/S2213-8587(14)70219-0.
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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, hospitalisation, disease registry and death certificate records from 1997 to 2010 in the CALIBER programme. We included 1·92 million people in England aged 30 and older who were free from cardiovascular disease at baseline. We compared cumulative incidence curves for the initial presentation of cardiovascular disease and used Cox models to estimate cause-specific hazard ratios. This study is registered at clinicaltrials.gov (NCT01804439). Findings We observed 113 638 first presentations of cardiovascular disease during a median follow-up of 5·5 years. Among the 34 198 people with type 2 diabetes, 6137 experienced a first cardiovascular presentation, of which the most common were peripheral arterial disease (16·2%) and heart failure (14·1%). Type 2 diabetes was positively associated with peripheral arterial disease (adjusted hazard ratio 2·98 [95% CI 2·76–3·22]), ischaemic stroke (1·72 [1·52–1·95]), stable angina (1·62 [CI 1·49– 1·77]), heart failure (1·56 [1·45–1·69]), and nonfatal 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]). With the exception of nonfatal MI in younger patients, where the association with T2D was stronger in women, we observed no other significant sex differences in these associations. 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.
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