Impact of Advanced Age on the Incidence of Major Adverse Cardiovascular Events in Patients with Type 2 Diabetes Mellitus and Stable Coronary Artery Disease in a Real-World Setting in Spain

Abstract

Patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) without myocardial infarction (MI) or stroke are at high risk for major cardiovascular events (MACEs). We aimed to provide real-world data on age-related clinical characteristics, treatment management, and incidence of major cardiovascular outcomes in T2DM-CAD patients in Spain from 2014 to 2018. We used EHRead^® technology, which is based on natural language processing and machine learning, to extract unstructured clinical information from electronic health records (EHRs) from 12 hospitals. Of the 4072 included patients, 30.9% were younger than 65 years (66.3% male), 34.2% were aged 65-75 years (66.4% male), and 34.8% were older than 75 years (54.3% male). These older patients were more likely to have hypertension (OR 2.85), angina (OR 1.64), heart valve disease (OR 2.13), or peripheral vascular disease (OR 2.38) than those aged <65 years (p < 0.001 for all comparisons). In general, they were also more likely to receive pharmacological and interventional treatments. Moreover, these patients had a significantly higher risk of MACEs (HR 1.29; p = 0.003) and ischemic stroke (HR 2.39; p < 0.001). In summary, patients with T2DM-CAD in routine clinical practice tend to be older, have more comorbidities, are more heavily treated, and have a higher risk of developing MACE than is commonly assumed from clinical trial data.

Keywords: MACE; aging; coronary artery disease; electronic health records; natural language processing; real-world data; type 2 diabetes mellitus.

Figure 1

Patient Flowchart. Abbreviations: CAD: coronary artery disease; EHR: electronic health records; T2DM: type 2 diabetes mellitus.

Figure 2

Cumulative incidence plot for major adverse cardiovascular events (MACEs) after 48 months of follow-up. The number of patients at risk across the follow-up period is indicated below.

Figure 3

Cumulative incidence plot for myocardial infarction (A), ischemic stroke (B), unstable angina (C), and urgent revascularization (D) after 48 months of follow-up. The number of patients at risk across the follow-up period is indicated below.