Abstract 18813: Microvascular Complications Predict Cardiovascular Disease In Type 2 Diabetes: A Population Study
Introduction: Diabetes confers a 2-fold excess risk of cardiovascular disease (CVD), yet predicting individual risk remains challenging. The effect of total microvascular disease burden on CVD risk among individuals with diabetes is unknown.
Hypothesis: Microvascular disease states alone or in unison are independently associated with CVD.
Methods: A population-based cohort of patients with type 2 diabetes from the UK Clinical Practice Research Datalink was studied (n=49 027). We used multivariable Cox models to estimate hazard ratios for the primary outcome (cardiovascular death, non-fatal myocardial infarction or non-fatal ischemic stroke) associated with cumulative burden of retinopathy, nephropathy and peripheral neuropathy among individuals with no history of cardiovascular disease at baseline.
Results: During a median follow-up of 5·5 years, 2822 (5·8%) individuals experienced a primary outcome. Significant associations were observed for the primary outcome individually for retinopathy, peripheral neuropathy, and nephropathy after adjustment for established risk factors. The hazard ratios (with 95% confidence intervals) were 1·39 (1·09-1·76), 1·40 (1·19-1·66), and 1·35 (1·15-1·58), respectively. For individuals with one, two or three microvascular disease states versus none, the multivariable-adjusted hazard ratios for the primary outcome were 1·32 (1·16-1·50), 1·62 (1·42-1·85) and 1.99 (1·70-2.34), respectively. Similar trends were observed for cardiovascular death, all cause mortality and for hospitalization for heart failure. Across the two AHA/ACC categories of cardiovascular risk (<7.5% and ≥7.5% 10-year risk of CVD), microvascular disease reclassified 9.1% of the cohort with 65.7% correct reclassification (net reclassification index 0.036, p<0.001).
Conclusions: The cumulative burden of microvascular disease significantly impacts the risk of future CVD among individuals with type 2 diabetes. Improvements in reclassification potentially offer correct intensity of statin therapy and the best net benefit, avoiding exposure of lower CVD risk patients to potentially unnecessary dose-dependent side-effects on higher intensity statins, which might affect compliance and patient engagement.
Author Disclosures: J. Brownrigg: None. H. Cian: None. K. Ray: Honoraria; Modest; Agerion, AbbVie, Amgen, Pfi zer, AstraZeneca, Sanofi / Regeneron, Cerenis, Medco, MSD, Roche, Kowa, Algorithm, Novartis, Novo Nordisk, Lily, Resverlogix, ISIS Pharma, Cipla, Takeda, Boehringer. R. Hinchliffe: Research Grant; Significant; Circulation Foundation.
- © 2016 by American Heart Association, Inc.