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.

中文翻译：

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2 型糖尿病诊断前几十年心血管疾病事件增加 2 倍：一项全国性的登记研究

 背景

2 型糖尿病 （T2DM） 患者患心血管疾病 （CVD） 的风险增加，但仍不确定 CVD 升高的发生时间比糖尿病诊断早多久。

 目标

本研究的目的是调查 T2DM 诊断前 30 年和诊断后 5 年的 CVD 发生率，并与匹配的比较进行比较。

 方法

这项病例对照和队列联合研究包括 2010 年至 2015 年间丹麦诊断患有 T2DM 的所有个体，以及按年龄和性别匹配的一般人群比较。CVD 定义为心肌梗死或缺血性卒中。条件 logistic 回归用于计算 T2DM 诊断前 30 年 CVD 患病率的 OR。Cox 比例风险回归模型用于计算 T2DM 诊断后 5 年 CVD 发病率的 HR。

 结果

该研究包括 127,092 名 T2DM 患者和 381,023 例匹配比较。在 T2DM 诊断之前的 30 年期间，14,179 名 （11.2%） T2DM 患者和 17,871 名 （4.7%） 比较者患有 CVD。T2DM 患者的 CVD 患病率高于 T2DM 诊断前整个时期的比较，ORs 范围从最早时期（诊断前 25-30 年）的 2.18 （95% CI： 1.91-2.48） 到最近时期的 2.96 （95% CI： 2.85-3.08） （诊断前 <5 年）。诊断为 T2DM 后，T2DM 个体的 5 年 CVD 发病率与对照组类似增加（HR：2.20;95% CI：2.12-2.27）。

 结论

从 T2DM 诊断前 3 年开始，T2DM 患者的 CVD 事件比匹配对照组多 2 倍。这表明，对于有 T2DM 风险的个体，全面的预防策略可能会更早地开始。