Cardiovascular risk and lifetime benefit from preventive treatment in type 2 diabetes: A post hoc analysis of the CAPTURE study

Abstract

Aim To assess the potential gain in the number of life‐years free of a (recurrent) cardiovascular disease (CVD) event with optimal cardiovascular risk management (CVRM) and initiation of glucose‐lowering agents with proven cardiovascular benefit in people with type 2 diabetes (T2D). Materials and Methods 9,416 individuals with T2D from the CAPTURE study, a non‐interventional, cross‐sectional, multinational study, were included. The diabetes lifetime‐perspective prediction model was used for calculating individual 10‐year and lifetime CVD risk. The distribution of preventive medication use was assessed according to predicted CVD risk and stratified for history of CVD. For the estimation of absolute individual benefit from lifelong preventive treatment, including optimal CVRM and the addition of glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) and sodium‐glucose co‐transporter‐2 inhibitors (SGLT‐2is), the model was combined with treatment effects from current evidence. Results GLP‐1 RA or SGLT‐2i use did not greatly differ between patients with and without CVD history, while use of blood pressure‐lowering medication, statins and aspirin was more frequent in patients with CVD. Mean (standard deviation [SD]) lifetime benefit from optimal CVRM was 3.9 (3.0) and 1.3 (1.9) years in patients with and without established CVD, respectively. Further addition of a GLP‐1 RA and an SGLT‐2i in patients with CVD gave an added mean (SD) lifetime benefit of 1.2 (0.6) years. Conclusions Life‐years gained free of (recurrent) CVD by optimal CVRM and the addition of a GLP‐1 RA or aSGLT‐2i is dependent on baseline CVD status. These results aid individualizing prevention and promote shared decision‐making in patients with T2D.

Atherosclerotic Cardiovascular Disease in Type 2 Diabetes: A Retrospective, Observational Study of Economic and Clinical Burden in Sweden

“…Statins are the first line of LDL-C-lowering therapy [ 33 ], and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are a therapeutic option for individuals who do not respond to statins [ 34 ]. Quantification of the precise benefits that could be gained by optimal cardiovascular risk management in people with T2D was outside the scope of our study, but a post hoc analysis of data from the CAPTURE study has attempted to address this question by estimating the life years that could be gained via the use of appropriate medications [ 35 ]. The societal impact of ASCVD demonstrated in our analyses suggests that public health initiatives aimed at limiting modifiable risk factors associated with CVD and T2D should also be a key health policy priority.…”