BMJ open · 2025
Cardiovascular disease and beta-cell function at diagnosis of serologically defined adult-onset type 1 and type 2 diabetes in two Swedish cohorts 15 years apart.
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Ritsinger Viveca, Gunnarsson Rebecka, Melin Eva, Hillman Magnus, Stogianni Anna, Holmberg Sara, Johansson Karin, Nilsson Neumark Ann-Sofie, Krol Herbert, Rööst Mattias, Landin-Olsson Mona, Neumark Thomas, Wanby Pär, Thunander Maria
Аннотация
OBJECTIVES: To describe the prevalence of cardiovascular disease (CVD) at the time of diagnosis of adult-onset type 1 (T1D) and type 2 (T2D) diabetes, in a recent cohort and compare to a previous cohort from the same region. Further, to explore factors influencing the prevalence of pre-existing CVD, including age, sex, body mass index (BMI) and C-peptide; in the later cohort also heart failure, hyperlipidaemia, tobacco use and physical activity.
DESIGN: Two prospective cross-sectional cohort studies compared.
SETTING: All primary health care centres and hospitals in Kalmar and Kronoberg counties in Southeastern Sweden.
PARTICIPANTS: Adults with newly diagnosed T1D or T2D (classified by combination of islet antibodies and C-peptide) in 1998-2001 and 2016-2017.
PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence of hypertension and CVD at diagnosis of diabetes, and associations with beta-cell function, in two cohorts collected 15 years apart. Further, to explore factors influencing the prevalence of hypertension and CVD, and level of C-peptide.
RESULTS: In patients with newly diagnosed T2D, mean age-at-onset had decreased (66±14.1 years vs 63±12.6, p≤0.001) and mean BMI had increased (29.0±5.4 vs 31.4±5.8 kg/m2, p≤0.001). Prevalence of pre-existing myocardial infarction had decreased in both T1D (18% vs 7%, p=0.03) and T2D (25% vs 11%, p≤0.001). Pre-existing hypertension had increased in both T1D (23% vs 40%, p=0.01) and T2D (44% vs 61%, p≤0.001). C-peptide level was lower and was associated with several cardiovascular conditions in newly diagnosed T2D in 2016-2017 (p=0.048 p≤0.001).
CONCLUSIONS: Patients with newly diagnosed T2D were younger, with higher BMI, compared with 15 years earlier, a challenge for diabetes care. Prevalence of pre-existing myocardial infarction had decreased notably, in line with, but still less than in the general population; while pre-existing hypertension had increased, in both diabetes types. C-peptide was associated with several cardiovascular conditions in newly diagnosed T2D in the recent cohort, which warrants further investigation.
DESIGN: Two prospective cross-sectional cohort studies compared.
SETTING: All primary health care centres and hospitals in Kalmar and Kronoberg counties in Southeastern Sweden.
PARTICIPANTS: Adults with newly diagnosed T1D or T2D (classified by combination of islet antibodies and C-peptide) in 1998-2001 and 2016-2017.
PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence of hypertension and CVD at diagnosis of diabetes, and associations with beta-cell function, in two cohorts collected 15 years apart. Further, to explore factors influencing the prevalence of hypertension and CVD, and level of C-peptide.
RESULTS: In patients with newly diagnosed T2D, mean age-at-onset had decreased (66±14.1 years vs 63±12.6, p≤0.001) and mean BMI had increased (29.0±5.4 vs 31.4±5.8 kg/m2, p≤0.001). Prevalence of pre-existing myocardial infarction had decreased in both T1D (18% vs 7%, p=0.03) and T2D (25% vs 11%, p≤0.001). Pre-existing hypertension had increased in both T1D (23% vs 40%, p=0.01) and T2D (44% vs 61%, p≤0.001). C-peptide level was lower and was associated with several cardiovascular conditions in newly diagnosed T2D in 2016-2017 (p=0.048 p≤0.001).
CONCLUSIONS: Patients with newly diagnosed T2D were younger, with higher BMI, compared with 15 years earlier, a challenge for diabetes care. Prevalence of pre-existing myocardial infarction had decreased notably, in line with, but still less than in the general population; while pre-existing hypertension had increased, in both diabetes types. C-peptide was associated with several cardiovascular conditions in newly diagnosed T2D in the recent cohort, which warrants further investigation.