Nationwide Trends in Cardiac Risk and Mortality in Patients With Incident Type 2 Diabetes: A Danish Cohort Study

Abstract

OBJECTIVE Trends in cardiac risk and death have not been examined in patients with incident type 2 diabetes and no prior cardiovascular disease. Therefore, we aimed to examine trends in cardiac risk and death in relation to the use of prophylactic cardiovascular medications in patients with incident type 2 diabetes without prior cardiovascular disease. RESEARCH DESIGN AND METHODS In this population-based cohort study, we included patients with incident type 2 diabetes between 1996 and 2011 through national health registries. Each patient was matched by age and sex with up to five individuals without diabetes from the general population. All individuals were followed for 7 years. RESULTS We identified 209,311 patients with incident diabetes. From 1996–1999 to 2008–2011, the 7-year risk of myocardial infarction decreased from 6.9 to 2.8% (adjusted hazard ratio [aHR] 0.39 [95% CI 0.37–0.42]), cardiac death from 7.1 to 1.6% (aHR 0.23 [95% CI 0.21–0.24]), and all-cause death from 28.9 to 16.8% (aHR 0.68 [95% CI 0.66–0.69]). Compared with the general population, 7-year risk differences decreased from 3.3 to 0.8% for myocardial infarction, from 2.7 to 0.5% for cardiac death, and from 10.6 to 6.0% for all-cause death. Use of cardiovascular medications within ±1 year of diabetes diagnosis, especially statins (5% of users in 1996–1999 vs. 60% in 2008–2011), increased during the study period. CONCLUSIONS From 1996 to 2011, Danish patients with incident type 2 diabetes and no prior cardiovascular disease experienced major reductions in cardiac risk and mortality. The risk reductions coincided with increased use of prophylactic cardiovascular medications.

Burden of established cardiovascular disease in people with type 2 diabetes and matched controls: Hospital‐based care, days absent from work, costs and mortality

“…Our findings are in line both with previous findings on increased resource use and costs, 5,[13][14][15]28 work absence 16,17,29 and mortality [2][3][4] in people with type 2 diabetes and with epidemiological data on prevalence of long-term diabetes complications 30 The study is based on a "young" type 2 diabetes sample but has national coverage. Inclusion in the database was conditioned on meeting diabetes inclusion criteria in ages 16 to 70 years.…”

“…2,3 A nationwide Danish study showed that individuals with newly diagnosed type 2 diabetes and no prior atherosclerotic cardiovascular disease had 7-year risks of myocardial infarction and cardiac death close to those of matched controls from the general population. 4 However, there was a persistent gap in all-cause mortality, 4 and a recent study indicated rising cumulative costs of cardiovascular and renal disease in type 2 diabetes in six countries with data follow-up of 2 to 10 years. 5 There is also a trend towards people living longer with type 2 diabetes, therefore, the concern regarding development of cardiovascular disease, albeit later, remains.…”

“…8,9 Preventing long-term complications of diabetes is an important part of diabetes management, not only because of the costs to the health sector but also because diabetes complications are associated with a negative health impact and a reduced quality of life. 10 Many studies report on the prevalence, incidence and time trends of cardiovascular disease in type 2 diabetes, 2,4,11 but few have analysed the distribution of the costs of diabetes complications over longer periods. 11,12 From the societal perspective, estimates of the costs of diabetes complications are important for understanding the key factors contributing to the burden of the disease.…”

“…Recent decades have seen downward trends in all‐cause and cardiovascular mortality among people with type 2 diabetes 2,3 . A nationwide Danish study showed that individuals with newly diagnosed type 2 diabetes and no prior atherosclerotic cardiovascular disease had 7‐year risks of myocardial infarction and cardiac death close to those of matched controls from the general population 4 . However, there was a persistent gap in all‐cause mortality, 4 and a recent study indicated rising cumulative costs of cardiovascular and renal disease in type 2 diabetes in six countries with data follow‐up of 2 to 10 years 5 …”

Healthcare Resource Utilization and Costs for Empagliflozin Versus Glucagon-Like Peptide-1 Receptor Agonists in Routine Clinical Care in Denmark

“…Patients with type 2 diabetes have recently experienced major reductions in risk of cardiovascular disease (CVD) and mortality compared with the general population [1]. Still, CVD remains the most frequent cause of mortality in patients with type 2 diabetes [2].…”