Increased risks for PAD, heart failure seen with type 2 diabetes

The risk for peripheral artery disease (PAD) increased nearly threefold when patients had type 2 diabetes compared to those who didn’t, according to findings published in the February issue of Lancet: Diabetes & Endocrinology.

The study used data from the CALIBER program (CArdiovascular disease research using LInked Bespoke studies and Electronic health Records), which allowed researchers to access records on nearly 2 million patients with and without type 2 diabetes. Anoop Dinesh Shah, MSc, RMCP, of the Farr Institute of Health Informatics Research at University College London, and colleagues analyzed the data to determine frequency and risk for 12 cardiovascular presentations. Cardiovascular outcomes included stable and unstable angina, MI, sudden coronary death, heart failure, transient ischemic attack, ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage, PAD, abdominal aortic aneurysm and a composite outcome.

Patients with type 2 diabetes, they found, were at increased risk for some, but not all of these outcomes. In particular, patients with diabetes presented first with PAD or heart failure most frequently (16.2 percent and 14.1 percent, respectively), representing a significant jump from patients without diabetes (9.4 percent and 12.2 percent, respectively). Patients with diabetes were at greatest risk from PAD (hazard ratio 2.98), ischemic stroke (1.72), stable angina (1.62), heart failure (1.56) or nonfatal MI (1.54).

However, Shah et al noted patients with diabetes had an inverse association with both subarachnoid hemorrhage and abdominal aortic aneurism (0.48 and 0.46, respectively). No increased risk for arrhythmia or sudden cardiac death was seen between patients with or without diabetes.

Glucose control, marked by HbA1C concentrations in patients with type 2 diabetes, also played a significant role for some forms of cardiovascular disease. Patients with HbA1C concentrations of less than 48 mmol per mol had increased risks for both PAD and ischemic stroke (1.82 and 1.53, respectively), but no others. Risk was highest for patients with HbA1c concentrations of 58 mmol per mol or more and among patients whose HbA1C results weren’t recorded.

In light of their findings, Shah et al suggested that future studies on diabetes patients should include chronic disease endpoints, especially PAD, heart failure and stable angina “because they are common, have a high morbidity burden and might have different treatment effects from myocardial infarction or stroke.”