Poster Abstracts
Type 2 diabetes and incidence of a wide range of cardiovascular diseases: a cohort study in 1·9 million people Anoop Dinesh Shah, Claudia Langenberg, Eleni Rapsomaniki, Spiros Denaxas, Mar Pujades-Rodriguez, Chris P Gale, John Deanfield, Liam Smeeth, Adam Timmis, Harry Hemingway
Abstract Published Online February 26, 2015 Poster 33 Farr Institute of Health Informatics Research, University College London, London, UK (A D Shah MRCP, E Rapsomaniki PhD, S Denaxas PhD, M Pujades-Rodriguez PhD, Prof H Hemingway FRCP); MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK (C Langenberg PhD); Faculty of Medicine and Health, University of Leeds, Leeds, UK (C P Gale FRCP); National Institute of Cardiovascular Outcomes Research, University College London, London, UK (Prof J Deanfield FRCP); Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK (Prof L Smeeth FRCGP); and Barts and the London National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK (Prof A Timmis FRCP) Correspondence to: Dr Anoop Dinesh Shah, UCL Institute of Health Informatics, Farr Institute of Health Informatics Research, 222 Euston Road, London NW1 2DA, UK [email protected]
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Background The contemporary associations of type 2 diabetes with a wide range of incident cardiovascular diseases have not been compared. Previous studies have focussed on myocardial infarction and stroke, and these conditions are the usual outcomes chosen in clinical trials in type 2 diabetes, but other diseases such as heart failure and angina are also major causes of morbidity in diabetes. We aimed to study associations between type 2 diabetes and 12 initial manifestations of cardiovascular disease. Methods We used linked electronic health records from 1997 to 2010 in the CALIBER (cardiovascular research using linked bespoke studies and electronic health records) programme to investigate the absolute and relative risks associated with type 2 diabetes in a cohort of 1·92 million patients in England. We included patients aged 30 years and older who were free from cardiovascular disease at baseline. This study is registered with ClinicalTrials.gov, number NCT01804439. Findings We observed 113 638 first presentations of cardiovascular disease during a median follow-up of 5·5 years (IQR 2·1–10·1). 34 198 people had type 2 diabetes: 6137 experienced a first cardiovascular presentation, of which the most common were peripheral arterial disease (16·2%, n=992) and heart failure (14·1%, n=866). Type 2 diabetes was strongly positively associated with peripheral arterial disease (adjusted cause-specific hazard ratio 2·98, 95% CI 2·76–3·22), ischaemic stroke (1·72, 1·52–1·95), stable angina (1·62, 1·49–1·77), heart failure (1·56, 1·45–1·69), and non-fatal myocardial infarction (1·54 1·42–1·67), but inversely associated with abdominal aortic aneurysm (0·46, 0·35–0·59) and subarachnoid haemorrhage (0·48, 0·26–0·89). Interpretation This study suggests that associations of type 2 diabetes vary with different incident cardiovascular diseases. These findings have implications for clinical risk assessment and choice of primary endpoint in trials on type 2 diabetes. Funding Wellcome Trust, National Institute for Health Research, UK Medical Research Council. Contributors ADS and ER analysed and interpreted the data. ADS drafted the report. SD prepared the data. HH was the principal investigator and had the original research idea. CL, ER, SD, MP-R, CPG, JD, LS, AT, and HH contributed to interpretation of results. ADS had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Declaration of interests We declare no competing interests.
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Type 2 diabetes and incidence of a wide range of cardiovascular diseases: a cohort study in 1·9 million people Anoop Dinesh Shah, Claudia Langenberg, Eleni Rapsomaniki, Spiros Denaxas, Mar Pujades-Rodriguez, Chris P Gale, John Deanfield, Liam Smeeth, Adam Timmis, Harry Hemingway
Abstract Published Online February 26, 2015 Poster 33 Farr Institute of Health Informatics Research, University College London, London, UK (A D Shah MRCP, E Rapsomaniki PhD, S Denaxas PhD, M Pujades-Rodriguez PhD, Prof H Hemingway FRCP); MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK (C Langenberg PhD); Faculty of Medicine and Health, University of Leeds, Leeds, UK (C P Gale FRCP); National Institute of Cardiovascular Outcomes Research, University College London, London, UK (Prof J Deanfield FRCP); Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK (Prof L Smeeth FRCGP); and Barts and the London National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK (Prof A Timmis FRCP) Correspondence to: Dr Anoop Dinesh Shah, UCL Institute of Health Informatics, Farr Institute of Health Informatics Research, 222 Euston Road, London NW1 2DA, UK [email protected]
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Background The contemporary associations of type 2 diabetes with a wide range of incident cardiovascular diseases have not been compared. Previous studies have focussed on myocardial infarction and stroke, and these conditions are the usual outcomes chosen in clinical trials in type 2 diabetes, but other diseases such as heart failure and angina are also major causes of morbidity in diabetes. We aimed to study associations between type 2 diabetes and 12 initial manifestations of cardiovascular disease. Methods We used linked electronic health records from 1997 to 2010 in the CALIBER (cardiovascular research using linked bespoke studies and electronic health records) programme to investigate the absolute and relative risks associated with type 2 diabetes in a cohort of 1·92 million patients in England. We included patients aged 30 years and older who were free from cardiovascular disease at baseline. This study is registered with ClinicalTrials.gov, number NCT01804439. Findings We observed 113 638 first presentations of cardiovascular disease during a median follow-up of 5·5 years (IQR 2·1–10·1). 34 198 people had type 2 diabetes: 6137 experienced a first cardiovascular presentation, of which the most common were peripheral arterial disease (16·2%, n=992) and heart failure (14·1%, n=866). Type 2 diabetes was strongly positively associated with peripheral arterial disease (adjusted cause-specific hazard ratio 2·98, 95% CI 2·76–3·22), ischaemic stroke (1·72, 1·52–1·95), stable angina (1·62, 1·49–1·77), heart failure (1·56, 1·45–1·69), and non-fatal myocardial infarction (1·54 1·42–1·67), but inversely associated with abdominal aortic aneurysm (0·46, 0·35–0·59) and subarachnoid haemorrhage (0·48, 0·26–0·89). Interpretation This study suggests that associations of type 2 diabetes vary with different incident cardiovascular diseases. These findings have implications for clinical risk assessment and choice of primary endpoint in trials on type 2 diabetes. Funding Wellcome Trust, National Institute for Health Research, UK Medical Research Council. Contributors ADS and ER analysed and interpreted the data. ADS drafted the report. SD prepared the data. HH was the principal investigator and had the original research idea. CL, ER, SD, MP-R, CPG, JD, LS, AT, and HH contributed to interpretation of results. ADS had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Declaration of interests We declare no competing interests.
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