Cardiovascular disease prevalence and risk factor prevalence in Type 2 diabetes: a contemporary analysis

McGurnaghan, Stuart J.; Blackbourn, Luke; Mocevic, Emina; Panton, Ulrik Haagen; McCrimmon, Rory J.; Sattar, Naveed; Wild, Sarah H.; Colhoun, Helen M.

doi:10.1111/dme.13825

Cited by 52 publications

(53 citation statements)

References 21 publications

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“…(27) In the current study, weighted prevalence of NAFLD among individuals with diabetes was approximately 54%. In addition, NAFLD has been reported to increase the risk of morbidity and mortality in persons with diabetes, (28)(29)(30) which is consistent with the increased risk of diabetes mortality and large proportion of diabetes deaths associated with NAFLD noted in the current study. Similarly, NAFLD has been reported to increase the risk of LD progression and mortality.…”

Section: Discussionsupporting

confidence: 90%

Attributable Fractions of Nonalcoholic Fatty Liver Disease for Mortality in the United States: Results From the Third National Health and Nutrition Examination Survey With 27 Years of Follow‐up

et al. 2020

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Background and Aims Nonalcoholic fatty liver disease (NAFLD) encompasses a range of conditions, from simple steatosis to nonalcoholic steatohepatitis. Studies in the United States have reported an increased mortality risk among individuals with NAFLD; therefore, the population attributable fractions (PAFs) for mortality were examined. Approach and Results A total of 12,253 adult individuals with ultrasound assessment of NAFLD from the Third National Health and Nutrition Examination Survey and mortality follow‐up through 2015 were included in the analysis. Cox proportional hazard regression was used to estimate multivariable‐adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for NAFLD in association with all‐cause and cause‐specific mortality. Overall, sex‐ and race/ethnicity‐specific PAFs and 95% CIs were estimated. In the current study, presence of NAFLD was associated with a 20% increased risk of all‐cause mortality (HR, 1.20; 95% CI, 1.08, 1.34). The overall PAF for all‐cause mortality associated with NAFLD was 7.5% (95% CI, 3.0, 12.0). The PAF for diabetes‐specific mortality was 38.0% (95% CI, 13.1, 63.0) overall, 40.8% (95% CI, 2.1, 79.6) in men, and 36.8% (95% CI, 6.6, 67.0) in women. The PAF for liver disease (LD)‐specific mortality was notably higher in men (68.3%; 95% CI, 36.3, 100.0) than women (3.5%; 95% CI, −39.7, 46.8). In the race‐specific analysis, the PAFs of NAFLD for all‐cause mortality (9.3%; 95% CI, 4.0, 14.6) and diabetes‐specific mortality (44.4%; 95% CI, 10.8, 78.0) were significantly greater than zero only for whites. Conclusions In the United States, approximately 8% of all‐cause mortality and more than one‐third of LD‐ and diabetes‐specific deaths are associated with NAFLD. With these high percentages, efforts are needed to reduce the burden of NAFLD in the United States.

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Section: Discussionsupporting

confidence: 90%

Attributable Fractions of Nonalcoholic Fatty Liver Disease for Mortality in the United States: Results From the Third National Health and Nutrition Examination Survey With 27 Years of Follow‐up

et al. 2020

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“…Similar findings to those of the present study were shown in two studies describing the real‐world use of glucose‐lowering therapies in patients at high CV risk using Scottish and United States‐based databases. Using a national registry linked to hospital admissions, a Scotland‐based study reported a higher percentage of patients with type 2 diabetes and established CV disease (44% of the total type 2 diabetes population, based on the LEADER inclusion criteria), and yet only 2.4% of this cohort were treated with a GLP‐1RA . Similarly, data from the US Diabetes Collaborative Registry showed that 48% of people with type 2 diabetes from a primary or secondary care setting would meet the same eligibility criteria for LEADER, but only 6% of these were prescribed a GLP‐1RA .…”

Section: Discussionmentioning

confidence: 99%

“…Scotland-based study reported a higher percentage of patients with type 2 diabetes and established CV disease (44% of the total type 2 diabetes population, based on the LEADER inclusion criteria), and yet only 2.4% of this cohort were treated with a GLP-1RA. 40 Similarly, data from the US Diabetes Collaborative Registry showed that 48% of people with type 2 diabetes from a primary or secondary care setting would meet the same eligibility criteria for LEADER, but only 6% of these were prescribed a GLP-1RA. 41 While it could be argued that the slow uptake of GLP-1RAs may be attributable to the reluctance of physicians to initiate injectable treatments in their patients with type 2 diabetes, analogous studies with oral glucose-lowering treatments with proven CV benefits, such as the SGLT2 inhibitor empagliflozin, showed a similar pattern to that observed with GLP-1RAs.…”

Section: Discussionmentioning

confidence: 99%

Real‐world prevalence of the inclusion criteria for the LEADER trial: Data from a national general practice network

Hinton

Feher

Munro

et al. 2019

Diabetes Obesity Metabolism

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Aims To explore the prevalence and describe the clinical characteristics of people with type 2 diabetes with a similar cardiovascular (CV) profile to that of the LEADER trial participants in a primary care setting in England. Materials and methods In this cross‐sectional analysis, using the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network database, we identified people with type 2 diabetes meeting the LEADER inclusion criteria. We identified people's CV risk factors using computerized medical records. Additionally, we assessed the prescription pattern of glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) in this cohort. Results Of 1 275 461 adults, we identified 84 394 with type 2 diabetes, of whom 14 000 (16.6%) met the LEADER inclusion criteria for established or high‐risk CV disease (RCGP RSC‐CVD group). The LEADER cohort was younger than the RCGP RSC‐CVD group (64.2 vs 73.2 years), had higher mean glycated haemoglobin (71.6 vs 67.1 mmol/mol) and blood pressure (BP) values (systolic BP: 135.9 vs 132.9 mmHg; diastolic BP: 77.2 vs 72.7 mmHg), and a higher mean body mass index (32.5 vs 30.9 kg/m 2 ). In the RCGP RSC‐CVD group, only 1215 people (8.7%) had ever been prescribed a GLP‐1RA and 760 (5.4%) had ever received liraglutide. Conclusions In a cohort of English general practice patients, one in six people with type 2 diabetes met the LEADER inclusion criteria, and less than one in 10 of these received liraglutide, a drug which has demonstrated CV benefits amongst others. There is scope to improve the outlook in people with type 2 diabetes and high CV risk through evidence‐based use of specific GLP‐1RAs.

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“…A recent analysis of national registry data from Scotland showed that 83.6% and 71.1% of T2D patients with and without CVD were on a statin, respectively (5). Similar figures have emerged from analyses of Norwegian (6) and US populations (7).…”

Section: Introductionmentioning

confidence: 99%

Type-2 diabetes with low LDL-C: genetic insights into a unique phenotype

Klimentidis

Arora

Newell

et al. 2019

Preprint

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21Although hyperlipidemia is traditionally considered a risk factor for type-2 diabetes (T2D), 22 evidence has emerged from statin trials and candidate gene investigations suggesting that lower 23 LDL-C increases T2D risk. We thus sought to comprehensively examine the phenotypic and 24 genotypic relationships of LDL-C with T2D. Using data from the UK Biobank, we found that 25 LDL-C was negatively associated with T2D (OR=0.43[0.41, 0.45] per mmol/L unit of LDL-C), 26 despite positive associations of LDL-C with HbA1c and BMI. We then performed the first 27 genome-wide exploration of variants simultaneously associated with lower LDL-C and increased 28 T2D risk, using data on LDL-C from the UK Biobank (n=431,167) and the GLGC consortium 29 (n=188,577), and T2D from the DIAGRAM consortium (n=898,130). We identified 31 loci 30 associated with lower LDL-C and increased T2D, capturing several potential mechanisms. Seven 31 of these loci have previously been identified for this phenotype, and 9 have previously been 32 implicated in non-alcoholic fatty liver disease. Finally, two-sample Mendelian randomization 33 analyses suggest that low LDL-C causes T2D, although causal interpretations are challenging 34 due to pleiotropy. Our findings extend our current understanding of the higher T2D risk among 35 individuals with low LDL-C, and of the underlying mechanisms, including those underlying the 36 diabetogenic effect of LDL-C-lowering medications. 38Rates of cardiovascular disease (CVD) and type-2 diabetes (T2D) are among the most 39 pressing health concerns worldwide. These two diseases share many risk factors, and tend to co-40 occur; T2D carries a 2-4 fold increase in risk for CVD, and more than 70% of patients with T2D 41 will die from cardiovascular complications (1). Yet, there remains controversy over whether all 42 risk factors exert similar effects on the risk of these two conditions. Low-density lipoprotein 43 cholesterol (LDL-C) is a class of highly atherogenic particles, and circulating levels of LDL-C 44 are a causal risk factor for CVD across the lifespan (2). Lipid lowering medications, in particular 45 from the statin drug class, are effective at lowering levels of LDL-C which has a dose-response 46 relationship with a reduction in adverse cardiovascular events (3). The perception of a strong 47 inter-relationship of T2D with hyperlipidemia, in particular higher LDL-C, has led to a standard 48 of care in which lipid-lowering medications are a common therapeutic option for T2D. For 49 example, the American Diabetes Association (ADA) recommends high intensity statin use for 50 individuals with diabetes with prevalent atherosclerotic cardiovascular disease (ASCVD) or a 51 greater than 20% 10-year risk of ASCVD until they reach recommended stringent targets of 52 LDL-C < 70mg/dL. The ADA further recommends moderate-intensity statin use for T2D 53 patients 40 years and older without ASCVD (4). 54A recent analysis of national registry data from Scotland showed that 83.6% and 71.1% 55 of T2D patients with and...

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Cardiovascular disease prevalence and risk factor prevalence in Type 2 diabetes: a contemporary analysis

Cited by 52 publications

References 21 publications

Attributable Fractions of Nonalcoholic Fatty Liver Disease for Mortality in the United States: Results From the Third National Health and Nutrition Examination Survey With 27 Years of Follow‐up

Attributable Fractions of Nonalcoholic Fatty Liver Disease for Mortality in the United States: Results From the Third National Health and Nutrition Examination Survey With 27 Years of Follow‐up

Real‐world prevalence of the inclusion criteria for the LEADER trial: Data from a national general practice network

Type-2 diabetes with low LDL-C: genetic insights into a unique phenotype

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