Recurrence of cardiovascular events in patients with type 2 diabetes: epidemiology and risk factors.

Abstract

Objective: To assess incidence and risk factors for recurrent cardiovascular disease (CVD) in Type 2 diabetes mellitus (T2DM)

Research Design and Methods– We estimated the incidence of recurrent cardiovascular events in T2DM patients, aged 40–97 years, followed by a network of diabetes clinics. The analysis was conducted separately for 2,788 patients with CVD at enrolment (cohort A) and for 844 patients developing the first episode during the observation period (cohort B).

Results – During 4 years of follow up, in cohort A the age-adjusted incidence of recurrent event (per 1,000 person-years) was 72.7 (95% C.I. 58.3–87.1) in men and 32.5 (95% C.I. 21.2–43.7) in women, whereas in cohort B it was 40.1 (95% C.I. 17.4–62.9) in men and 22.4 (95% C.I. 12.9 – 32.0) in women. After controlling for potential predictors (familial CVD, obesity, smoking, diabetes duration, glycaemic control, microvascular complications, geographic area, anti-hypertensive and lipid-lowering treatment), male gender, older age and insulin use were significant, independent risk predictors (cohort A); serum triglyceride levels ≥1.69 mmom/l emerged as the only metabolic (negative) prognostic factor (cohort B). In both cohorts, the prior CVD episode, especially MI, was by far the strongest predictor of relapsing CVD.

Conclusions – Approximately 6% of unselected diabetic patients in secondary prevention develop recurrent major CVD every year. Those with long-standing previous CVD show higher incidence of recurrence. Male gender, age, high triglycerides and insulin use are predictors of recurrence in addition to the history of previous CVD.