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Microvascular disease increases risk for CV events in type 2 diabetes
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In adults with type 2 diabetes free of cardiovascular disease, the burden of microvascular disease confers a risk for future cardiovascular events similar to the risks observed from smoking, hypertension and dyslipidemia, according to recent study findings.
“The risk of a first [CV] event increased linearly with the number of manifestations of microvascular disease present,” Jack R.W. Brownrigg, MRCS, of St. George’s Vascular Institute and St. George’s University of London, and colleagues wrote. “Furthermore, the presence of isolated retinopathy, peripheral neuropathy or nephropathy confers at least a similar risk for [CV] events as risk factors contained in contemporary risk equations, such as blood pressure, LDL cholesterol and HbA1c.”
Brownrigg and colleagues analyzed data from 49,027 patients with type 2 diabetes and no history of CVD at baseline. Participants were identified through the U.K. Clinical Practice Research Datalink. Researchers used Cox regression analyses to estimate HRs for time to first major CV event (a composite of CV death, nonfatal myocardial infarction or nonfatal ischemic stroke) associated with cumulative burden of retinopathy, nephropathy and peripheral neuropathy.
After adjustment for established risk factors, researchers found an association between retinopathy (HR = 1.39; 95% CI, 1.09-1.76), peripheral neuropathy (HR = 1.4; 95% CI, 1.19-1.66) and nephropathy (HR = 1.35; 95% CI, 1.15-1.58) and first major CV event. Patients with increasing microvascular disease burden saw increasing risk for a major CV event vs. patients with no microvascular disease. After adjustment, HR for patients with one microvascular disease was 1.32 (95% CI, 1.16-1.5); HR for patients with two microvascular diseases was 1.62 (95% CI, 1.42-1.85); and HR for patients with three microvascular diseases was 1.99 (95% CI, 1.7-2.34).
Researchers also found that, across the American College of Cardiology and American Heart Association categories of CV risk, microvascular disease reclassified 9.1% of the cohort in higher or lower risk groups as defined by U.S. guidelines (net reclassification index = 0.036; 95% CI, 0.017-0.055), and reclassified 10.6% of the cohort according to U.K. guidelines (net reclassification index = 0.038; 95% CI, 0.013-0.06). – by Regina Schaffer
Disclosure: This study was supported by a grant from the Circulation Foundation. Please see the full study for the researchers’ relevant financial disclosures.
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