Type 2 Diabetes With Microvascular Disease Increases Risk of Cardiovascular Death

There is a significantly higher risk for cardiovascular morbidities and mortality among patients with type 2 diabetes (T2D) with microvascular disease vs those without microvascular disease. These findings were published in Cardiovascular Diabetology.

Investigators sought to compare risks for macrovascular disease development among patients with T2D with and without microvascular disease. They also compared matched patients with diabetic retinopathy vs diabetic neuropathy, diabetic kidney disease vs diabetic neuropathy, and diabetic kidney disease vs diabetic retinopathy for the same risks. Primary outcomes were development of heart failure, stroke, coronary artery disease, and cardiovascular death.

They conducted a retrospective nationwide cohort study using the National Health Insurance Research Database in Taiwan to identify newly diagnosed T2D patients from January 2008, through December 2019, using ICD-9 and ICD-10 codes. Patients were propensity score matched for diabetic neuropathy, diabetic retinopathy, and diabetic kidney disease.

Patients were between the ages of 18 and 80 years. Risk of outcomes between patients with and without microvascular disease were measured using multivariable-adjusted Cox proportional-hazard models.

Among patients with T2D, there were 718,059 without microvascular disease; 46,634 with diabetic kidney disease; 51,887 with diabetic neuropathy; 15,778 with diabetic retinopathy; 36,850 with diabetic kidney disease and neuropathy; 11,763 with diabetic kidney disease and retinopathy; 10,917 with diabetic retinopathy and neuropathy; and 8934 with diabetic kidney disease, retinopathy, and neuropathy (mean follow-up, 5.55 years).

Patients with T2D and microvascular disease vs those without microvascular disease had a significantly higher risk for cardiovascular morbidities and mortality. Patients with diabetic retinopathy vs those with diabetic kidney disease had significantly higher risk for stroke (adjusted hazard ratio [aHR], 1.11; 95% CI, 1.03-1.20) among the matched pairs. Patients with diabetic retinopathy vs those with diabetic kidney disease had a significantly higher risk for incident heart failure (aHR, 1.43; 95% CI, 1.30-1.57).

Patients with diabetic neuropathy vs those with diabetic kidney disease had a significantly higher risk for stroke (aHR, 1.17; 95% CI, 1.10-1.25) as did patients with diabetic neuropathy vs those with diabetic retinopathy (aHR, 1.12; 95% CI, 1.03-1.21).

Patients with diabetic neuropathy vs those with diabetic retinopathy had a significantly lower risk for incident heart failure (aHR, 0.79; 95% CI, 0.71-0.87).

Study limitations include a lack of information on neurological, biochemical, blood glucose, proteinuria, renal function, imaging, and pathology findings. There is also missing information on alcohol consumption, family history, exercise, and dietary habits.

“Our study shows that microvascular diseases early in the diagnosis of type 2 diabetes are closely associated with the development of coronary artery disease, stroke, heart failure, and cardiovascular death,” the study authors wrote. “Furthermore, people with one, two or three microvascular diseases signify an even higher risk of cardiovascular morbidity and mortality than those without microvascular disease.”

This article originally appeared on The Cardiology Advisor