Prevalence of Established Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus in the UK

Abstract

Introduction: The results of recently completed cardiovascular outcomes trials in patients with type 2 diabetes mellitus (T2DM) suggest that sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide (GLP) 1 receptor agonists have enhanced cardioprotective properties in patients with established cardiovascular disease (eCVD), but to a lesser degree in those without eCVD. SGLT2 inhibitors appear to be particularly beneficial in patients with heart failure. As recent data for the UK are lacking, we undertook to identify the percentage of T2DM patients with eCVD and heart failure in the UK.

Methods: This was a retrospective cohort study that utilized the Clinical Practice Research Datalink (CPRD) database in the UK. We included de-identified adult patients with T2DM with at least one encounter in the CPRD database between 1 January 2018 and 31 December 2018 in the analysis and extracted the full health records of these patients. eCVD was defined as myocardial infarction, stroke, unstable angina pectoris, coronary artery disease and peripheral artery disease. We further assessed the number of patients with heart failure.

Results: From the total of 148,803 patients with T2DM analyzed (53% were male; mean age was 65 years), 52,601 (35.4%) suffered from eCVD and 8650 (5.8%) suffered from heart failure (73.7% of patients with heart failure overlap with those with atherothrombotic eCVD). Glycated hemoglobin levels of < 7% were attained by 49.5% of patients (with eCVD, 49.7%; without eCVD, 49.3%) (p < 0.001).

Conclusion: Approximately one-third of patients with T2DM in the UK have concomitant CVD.

Funding: Merck Sharp & Dohme Corp., a subsidiary Merck & Co., Inc., Kenilworth, NJ, USA.

Keywords: Cardiovascular disease; Chronic kidney disease; Heart failure.

Fig. 1

Venn diagram showing distribution of cardiovascular disease among patients with type 2 diabetes mellitus in the UK

Fig. 2

Distribution of stages of chronic kidney disease (CKD) according to the National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (K/DOQI) based on guidelines on estimated glomerular filtration rate. eCVD Established cardiovascular disease. Normal or CKD stage 1: > 90 mLmin/1.73 m², CKD stage 2: 60–89 mL/min/1.73 m²; CKD stage 3a: 45–59 mL/min/1.73 m²; CKD stage 3b: 30–44 mL/min/1.73 m²; CKD stage 4: 15–29 mL/min/1.73 m²; CKD stage 5: < 15 mL/min/1.73 m²