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. 2024 Dec 3;84(23):2251-2259.
doi: 10.1016/j.jacc.2024.06.050.

2-Fold More Cardiovascular Disease Events Decades Before Type 2 Diabetes Diagnosis: A Nationwide Registry Study

Christine Gyldenkerne  1 , Johnny Kahlert  2 , Pernille G Thrane  3 , Kevin K W Olesen  3 , Martin B Mortensen  4 , Henrik T Sørensen  2 , Reimar W Thomsen  2 , Michael Maeng  5
Affiliations

2-Fold More Cardiovascular Disease Events Decades Before Type 2 Diabetes Diagnosis: A Nationwide Registry Study

Christine Gyldenkerne et al. J Am Coll Cardiol. .

Abstract

Background: The risk of cardiovascular disease (CVD) is increased in individuals with type 2 diabetes mellitus (T2DM), but it remains uncertain how long an elevated CVD occurrence precedes diabetes diagnosis.

Objectives: The aim of this study was to investigate CVD occurrence 30 years before, and 5 years after, T2DM diagnosis compared with matched comparisons.

Methods: This combined case-control and cohort study included all individuals diagnosed with T2DM in Denmark between 2010 and 2015, as well as general population comparisons matched by age and sex. CVD was defined as myocardial infarction or ischemic stroke. Conditional logistic regression was used to compute ORs for CVD prevalence in the 30-year period before T2DM diagnosis. Cox proportional hazards regression models were used to compute HRs for 5-year CVD incidence after T2DM diagnosis.

Results: The study included 127,092 individuals with T2DM and 381,023 matched comparisons. In the 30-year period before T2DM diagnosis, 14,179 (11.2%) T2DM individuals and 17,871 (4.7%) comparisons experienced CVD. CVD prevalence was higher in those with T2DM than the comparisons in the entire period before T2DM diagnosis, with ORs ranging from 2.18 (95% CI: 1.91-2.48) in the earliest period (25-30 years before diagnosis) to 2.96 (95% CI: 2.85-3.08) in the latest period (<5 years before diagnosis). After T2DM diagnosis, 5-year CVD incidence was similarly increased in T2DM individuals vs comparisons (HR: 2.20; 95% CI: 2.12-2.27).

Conclusions: Individuals with T2DM had 2-fold more CVD events than matched comparisons starting 3 decades before T2DM diagnosis. This indicates that comprehensive preventive strategies may be initiated much earlier in individuals at risk of T2DM.

Keywords: cardiovascular disease; case-control study; cohort study; epidemiology; primary prevention; type 2 diabetes.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Gyldenkerne is supported by a scholarship from Aarhus University. The funding source had no influence on the study design, conduct and interpretation of the data, or the decision to submit this manuscript for publication. Dr Maeng is supported by the Borregaard Clinical Ascending Investigator Research Grant financed by the Novo Nordisk Foundation (grant NNF22OC0074083); has received lecture and/or advisory board fees from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, and Novo Nordisk; has received research grants from Philips, Bayer, and Novo Nordisk; has received a travel grant from Novo Nordisk; has ongoing research contracts with Janssen, Novo Nordisk, and Philips; and is a minor shareholder in Eli Lilly & Company, Novo Nordisk, and Verve Therapeutics. The Department of Clinical Epidemiology, Aarhus University Hospital, receives funding for other studies from companies in the form of research grants to (and administered by) Aarhus University. Dr Olesen is supported by the Danish Cardiovascular Academy, which is funded by the Novo Nordisk Foundation (grant NNF20SA0067242) and The Danish Heart Foundation. None of these studies have any relation to the current study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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