Clinical cardiovascular phenotypes and the pattern of future events in patients with type 2 diabetes

Mariam Elmegaard Malik; Charlotte Andersson; Paul Blanche; Maria D'Souza; Christian Madelaire; Bochra Zareini; Morten Lamberts; Søren Lund Kristensen; Naveed Sattar; John McMurray; Lars Køber; Christian Torp-Pedersen; Gunnar Gislason; Morten Schou

doi:10.1007/s00392-022-02016-z

Clinical cardiovascular phenotypes and the pattern of future events in patients with type 2 diabetes

Mariam Elmegaard Malik, Charlotte Andersson, Paul Blanche, Maria D'Souza, Christian Madelaire, Bochra Zareini, Morten Lamberts, Søren Lund Kristensen, Naveed Sattar, John McMurray, Lars Køber, Christian Torp-Pedersen, Gunnar Gislason, Morten Schou

2 Citationer (Scopus)

Abstract

IMPORTANCE: Updated guidelines on diabetes recommend targeting sodium-glucose cotransporter-2 inhibitors (SGLT2i) at patients at risk of heart failure (HF) and glucagon-like peptide-1 receptor agonists (GLP1-RA) at those at greater risk of atherothrombotic events.

OBJECTIVE: We estimated the risk of different cardiovascular events in patients with type 2 diabetes (T2D) and newly established cardiovascular disease.

DESIGN, SETTING AND PARTICIPANTS: Patients with T2D and newly established cardiovascular disease from 1998 to 2016 were identified using Danish healthcare registers and divided into one of four phenotype groups: (1) HF, (2) ischemic heart disease (IHD), (3) transient ischemic stroke (TIA)/ischemic stroke, and (4) peripheral artery disease (PAD). The absolute 5-year risk of the first HF- or atherothrombotic event occurring after inclusion was calculated, along with the risk of death.

MAIN OUTCOMES AND MEASURES: The main outcome was the first event of either HF or an atherothrombotic event (IHD, TIA/ischemic stroke or PAD) in patients with T2D and new-onset cardiovascular disease.

RESULTS: Of the 37,850 patients included, 40% were female and the median age was 70 years. Patients with HF were at higher 5-year risk of a subsequent HF event (17.9%; 95% confidence interval (CI) 17.1-18.8%) than an atherothrombotic event (15.8%; 15.0-16.6%). Patients with IHD were at higher risk of a subsequent atherothrombotic event (24.6%; 23.9-25.3%) than developing HF, although the risk of HF was still substantial (10.6%; 10.2-11.1%). Conversely, patients with PAD were at low risk of developing HF (4.4%; 3.8-5.1%) but at high risk of developing an atherothrombotic event (15.9%; 14.9-17.1%). Patients with TIA/ischemic stroke had the lowest risk of HF (3.2%; 2.9-3.6%) and the highest risk of an atherothrombotic event (20.6%; 19.8-21.4).

CONCLUSIONS: In T2D, a patient's cardiovascular phenotype can help predict the pattern of future cardiovascular events.

Originalsprog	Engelsk
Tidsskrift	Clinical research in cardiology : official journal of the German Cardiac Society
Vol/bind	112
Udgave nummer	2
Sider (fra-til)	215-226
Antal sider	12
ISSN	1861-0684
DOI	https://doi.org/10.1007/s00392-022-02016-z
Status	Udgivet - feb. 2023

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10.1007/s00392-022-02016-z

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Malik, M. E., Andersson, C., Blanche, P., D'Souza, M., Madelaire, C., Zareini, B., Lamberts, M., Kristensen, S. L., Sattar, N., McMurray, J., Køber, L., Torp-Pedersen, C., Gislason, G., & Schou, M. (2023). Clinical cardiovascular phenotypes and the pattern of future events in patients with type 2 diabetes. Clinical research in cardiology : official journal of the German Cardiac Society, 112(2), 215-226. https://doi.org/10.1007/s00392-022-02016-z

Clinical cardiovascular phenotypes and the pattern of future events in patients with type 2 diabetes. / Malik, Mariam Elmegaard; Andersson, Charlotte; Blanche, Paul et al.
I: Clinical research in cardiology : official journal of the German Cardiac Society, Bind 112, Nr. 2, 02.2023, s. 215-226.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Malik, ME, Andersson, C, Blanche, P, D'Souza, M, Madelaire, C, Zareini, B, Lamberts, M, Kristensen, SL, Sattar, N, McMurray, J, Køber, L , Torp-Pedersen, C , Gislason, G & Schou, M 2023, 'Clinical cardiovascular phenotypes and the pattern of future events in patients with type 2 diabetes', Clinical research in cardiology : official journal of the German Cardiac Society, bind 112, nr. 2, s. 215-226. https://doi.org/10.1007/s00392-022-02016-z

@article{5e8b9c33462b497baa0a1ca8280e39fb,

title = "Clinical cardiovascular phenotypes and the pattern of future events in patients with type 2 diabetes",

abstract = "IMPORTANCE: Updated guidelines on diabetes recommend targeting sodium-glucose cotransporter-2 inhibitors (SGLT2i) at patients at risk of heart failure (HF) and glucagon-like peptide-1 receptor agonists (GLP1-RA) at those at greater risk of atherothrombotic events.OBJECTIVE: We estimated the risk of different cardiovascular events in patients with type 2 diabetes (T2D) and newly established cardiovascular disease.DESIGN, SETTING AND PARTICIPANTS: Patients with T2D and newly established cardiovascular disease from 1998 to 2016 were identified using Danish healthcare registers and divided into one of four phenotype groups: (1) HF, (2) ischemic heart disease (IHD), (3) transient ischemic stroke (TIA)/ischemic stroke, and (4) peripheral artery disease (PAD). The absolute 5-year risk of the first HF- or atherothrombotic event occurring after inclusion was calculated, along with the risk of death.MAIN OUTCOMES AND MEASURES: The main outcome was the first event of either HF or an atherothrombotic event (IHD, TIA/ischemic stroke or PAD) in patients with T2D and new-onset cardiovascular disease.RESULTS: Of the 37,850 patients included, 40\% were female and the median age was 70 years. Patients with HF were at higher 5-year risk of a subsequent HF event (17.9\%; 95\% confidence interval (CI) 17.1-18.8\%) than an atherothrombotic event (15.8\%; 15.0-16.6\%). Patients with IHD were at higher risk of a subsequent atherothrombotic event (24.6\%; 23.9-25.3\%) than developing HF, although the risk of HF was still substantial (10.6\%; 10.2-11.1\%). Conversely, patients with PAD were at low risk of developing HF (4.4\%; 3.8-5.1\%) but at high risk of developing an atherothrombotic event (15.9\%; 14.9-17.1\%). Patients with TIA/ischemic stroke had the lowest risk of HF (3.2\%; 2.9-3.6\%) and the highest risk of an atherothrombotic event (20.6\%; 19.8-21.4).CONCLUSIONS: In T2D, a patient's cardiovascular phenotype can help predict the pattern of future cardiovascular events.",

keywords = "Cardiovascular disease, Epidemiology, Heart failure, Type 2 diabetes",

author = "Malik, \{Mariam Elmegaard\} and Charlotte Andersson and Paul Blanche and Maria D'Souza and Christian Madelaire and Bochra Zareini and Morten Lamberts and Kristensen, \{S{\o}ren Lund\} and Naveed Sattar and John McMurray and Lars K{\o}ber and Christian Torp-Pedersen and Gunnar Gislason and Morten Schou",

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year = "2023",

month = feb,

doi = "10.1007/s00392-022-02016-z",

language = "English",

volume = "112",

pages = "215--226",

journal = "Clinical research in cardiology : official journal of the German Cardiac Society",

issn = "1861-0684",

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TY - JOUR

T1 - Clinical cardiovascular phenotypes and the pattern of future events in patients with type 2 diabetes

AU - Malik, Mariam Elmegaard

AU - Andersson, Charlotte

AU - Blanche, Paul

AU - D'Souza, Maria

AU - Madelaire, Christian

AU - Zareini, Bochra

AU - Lamberts, Morten

AU - Kristensen, Søren Lund

AU - Sattar, Naveed

AU - McMurray, John

AU - Køber, Lars

AU - Torp-Pedersen, Christian

AU - Gislason, Gunnar

AU - Schou, Morten

PY - 2023/2

Y1 - 2023/2

N2 - IMPORTANCE: Updated guidelines on diabetes recommend targeting sodium-glucose cotransporter-2 inhibitors (SGLT2i) at patients at risk of heart failure (HF) and glucagon-like peptide-1 receptor agonists (GLP1-RA) at those at greater risk of atherothrombotic events.OBJECTIVE: We estimated the risk of different cardiovascular events in patients with type 2 diabetes (T2D) and newly established cardiovascular disease.DESIGN, SETTING AND PARTICIPANTS: Patients with T2D and newly established cardiovascular disease from 1998 to 2016 were identified using Danish healthcare registers and divided into one of four phenotype groups: (1) HF, (2) ischemic heart disease (IHD), (3) transient ischemic stroke (TIA)/ischemic stroke, and (4) peripheral artery disease (PAD). The absolute 5-year risk of the first HF- or atherothrombotic event occurring after inclusion was calculated, along with the risk of death.MAIN OUTCOMES AND MEASURES: The main outcome was the first event of either HF or an atherothrombotic event (IHD, TIA/ischemic stroke or PAD) in patients with T2D and new-onset cardiovascular disease.RESULTS: Of the 37,850 patients included, 40% were female and the median age was 70 years. Patients with HF were at higher 5-year risk of a subsequent HF event (17.9%; 95% confidence interval (CI) 17.1-18.8%) than an atherothrombotic event (15.8%; 15.0-16.6%). Patients with IHD were at higher risk of a subsequent atherothrombotic event (24.6%; 23.9-25.3%) than developing HF, although the risk of HF was still substantial (10.6%; 10.2-11.1%). Conversely, patients with PAD were at low risk of developing HF (4.4%; 3.8-5.1%) but at high risk of developing an atherothrombotic event (15.9%; 14.9-17.1%). Patients with TIA/ischemic stroke had the lowest risk of HF (3.2%; 2.9-3.6%) and the highest risk of an atherothrombotic event (20.6%; 19.8-21.4).CONCLUSIONS: In T2D, a patient's cardiovascular phenotype can help predict the pattern of future cardiovascular events.

AB - IMPORTANCE: Updated guidelines on diabetes recommend targeting sodium-glucose cotransporter-2 inhibitors (SGLT2i) at patients at risk of heart failure (HF) and glucagon-like peptide-1 receptor agonists (GLP1-RA) at those at greater risk of atherothrombotic events.OBJECTIVE: We estimated the risk of different cardiovascular events in patients with type 2 diabetes (T2D) and newly established cardiovascular disease.DESIGN, SETTING AND PARTICIPANTS: Patients with T2D and newly established cardiovascular disease from 1998 to 2016 were identified using Danish healthcare registers and divided into one of four phenotype groups: (1) HF, (2) ischemic heart disease (IHD), (3) transient ischemic stroke (TIA)/ischemic stroke, and (4) peripheral artery disease (PAD). The absolute 5-year risk of the first HF- or atherothrombotic event occurring after inclusion was calculated, along with the risk of death.MAIN OUTCOMES AND MEASURES: The main outcome was the first event of either HF or an atherothrombotic event (IHD, TIA/ischemic stroke or PAD) in patients with T2D and new-onset cardiovascular disease.RESULTS: Of the 37,850 patients included, 40% were female and the median age was 70 years. Patients with HF were at higher 5-year risk of a subsequent HF event (17.9%; 95% confidence interval (CI) 17.1-18.8%) than an atherothrombotic event (15.8%; 15.0-16.6%). Patients with IHD were at higher risk of a subsequent atherothrombotic event (24.6%; 23.9-25.3%) than developing HF, although the risk of HF was still substantial (10.6%; 10.2-11.1%). Conversely, patients with PAD were at low risk of developing HF (4.4%; 3.8-5.1%) but at high risk of developing an atherothrombotic event (15.9%; 14.9-17.1%). Patients with TIA/ischemic stroke had the lowest risk of HF (3.2%; 2.9-3.6%) and the highest risk of an atherothrombotic event (20.6%; 19.8-21.4).CONCLUSIONS: In T2D, a patient's cardiovascular phenotype can help predict the pattern of future cardiovascular events.

KW - Cardiovascular disease

KW - Epidemiology

KW - Heart failure

KW - Type 2 diabetes

UR - https://www.scopus.com/pages/publications/85127691760

U2 - 10.1007/s00392-022-02016-z

DO - 10.1007/s00392-022-02016-z

M3 - Journal article

C2 - 35396632

SN - 1861-0684

VL - 112

SP - 215

EP - 226

JO - Clinical research in cardiology : official journal of the German Cardiac Society

JF - Clinical research in cardiology : official journal of the German Cardiac Society

IS - 2

ER -

Clinical cardiovascular phenotypes and the pattern of future events in patients with type 2 diabetes

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