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Observational Study
. 2021 Jul;12(7):1175-1182.
doi: 10.1111/jdi.13464. Epub 2020 Dec 15.

Cardiovascular events and mortality in people with and without type 2 diabetes: An observational study in a contemporary multi-ethnic population

Briana Coles  1 , Francesco Zaccardi  1 , Suping Ling  1 , Melanie J Davies  2 , Nilesh J Samani  3 , Kamlesh Khunti  4
Affiliations
Observational Study

Cardiovascular events and mortality in people with and without type 2 diabetes: An observational study in a contemporary multi-ethnic population

Briana Coles et al. J Diabetes Investig. 2021 Jul.

Abstract

Aims/introduction: The aim of this study was to examine ethnicity-specific associations between type 2 diabetes mellitus and the risk of a cardiovascular disease (CVD) event as well as risk of specific CVD phenotypes in England.

Methods: We obtained data from the Clinical Practice Research Datalink for adults with and without type 2 diabetes mellitus diagnosed 2000-2006. The outcome was the first CVD event during 2007-2017 and the following components: aortic aneurysm, cerebrovascular accidents, heart failure, myocardial infarction, peripheral vascular disease and other CVD-related conditions. Flexible parametric survival models were used to estimate ethnicity-specific adjusted hazard ratios.

Results: A total of 734,543 people with and without type 2 diabetes mellitus (29,847; 4.1%) were included; most were of white ethnicity (93.0% with and 92.3% without type 2 diabetes mellitus) followed by South Asian (3.2 and 4.6%). During a median follow-up period of 11.0 years, 67,218 events occurred (6,156 in individuals with type 2 diabetes mellitus). Type 2 diabetes mellitus was associated with a small increase in CVD events (adjusted hazard ratio 1.06, 95% confidence interval 1.02-1.09) in individuals of white ethnicity; whereas the adjusted hazard ratios were considerably higher in individuals of South Asian ethnicity (1.28, 95% confidence interval 1.09-1.51), primarily due to an increased risk of myocardial infarction (1.53, 95% confidence interval 1.08-2.18).

Conclusions: Despite universal access to healthcare, there are large disparities in CVD outcomes in people with and without type 2 diabetes mellitus. Other non-traditional risk factors might play a role in the higher CVD risk associated with type 2 diabetes mellitus in individuals of South Asian ethnicity.

Keywords: Ethnic groups; Risk factors; Type 2 diabetes.

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Conflict of interest statement

KK is consultant and speaker for Amgen, AstraZeneca, Bayer, NAPP, Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Roche, Berlin‐Chemie AG/ Menarini Group, Sanof‐Aventis, Servier and Boerhringer Inghelheim; and received grants from Pfizer, Boehringer Ingelheim, AstraZeneca, Novartis, Novo Nordisk, Sanofi‐Aventis, Lilly, Merck Sharp & Dohme and Servier. MJD is consultant, advisory board member and speaker for Novo Nordisk, Sanofi‐Aventis, Lilly, Merck Sharp & Dohme, Boehringer Ingelheim, AstraZeneca and Janssen; an advisory board member for Servier; and a speaker for Mitsubishi Tanabe Pharma Corporation and Takeda Pharmaceuticals International Inc. She has received grants in support of investigator and investigator initiated trials from Novo Nordisk, Sanofi‐Aventis, Lilly, Boehringer Ingelheim and Janssen. The other authors declare no conflict of interest.

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