Diabetes Complications and Comorbidities as Risk Factors for MACE in People With Type 2 Diabetes and Their Development Over Time: A Danish Registry-Based Case-Control Study.

AIM: This study aimed to investigate the association between cardiovascular risk factors and major adverse cardiovascular events (MACE) in people with type 2 diabetes, while assessing potential changes over time.

METHODS

Utilizing data from Danish registries, this study identified people with type 2 diabetes between 2002 and 2021 (n = 372 328) and subdivided them into two 10-year time periods: TP1: 2002-2011 and TP2: 2012-2021, and further categorized into cases and controls. Cases were defined as having suffered a first-time three-point MACE (nTP1 = 12 713, nTP2 = 8981) and matched 1:1 with controls on age, sex, and type 2 diabetes duration. Exposures were preselected diabetes complications and comorbidities.

RESULTS

Fewer were affected by MACE during TP2 compared to TP1 (p < 0.001). Diabetes complications associated with MACE were nephropathy (ORTP1 = 1.54, 95% CI 1.30-1.83, ORTP2 = 1.47, 95% CI 1.20-1.79), neuropathy (ORTP1 = 2.02, 95% CI 1.84-2.21 ORTP2 = 1.58, 95% CI 1.44-1.73) and retinopathy (ORTP1 = 1.10, 95% CI 0.98-1.23, ORTP2 = 1.38, 95% CI 1.17-1.63). Comorbidities associated with MACE included hypertension (ORTP1 = 1.30, 95% CI 1.22-1.38 ORTP2 = 1.31, 95% CI 1.22-1.41), atrial flutter or fibrillation (ORTP1 = 1.46, 95% CI 1.35-1.58, ORTP2 = 1.37, 95% CI 1.26-1.50), heart failure (ORTP1 = 1.53, 95% CI 1.401.67-, ORTP2 = 1.37, 95% CI 1.23-1.54) and hypercholesterolemia (ORTP1 = 1.13, 95% CI 1.07-1.20, ORTP2 = 1.02, 95% CI 0.96-1.10). Hypercholesterolemia (p = 0.038) and neuropathy (p = 0.038) exhibited a significant decrease in association with MACE between the time periods.

CONCLUSIONS

The prevalence of first-time MACE decreased over time, despite a relatively stable prevalence of type 2 diabetes. Several diabetes-related complications and comorbidities were significantly associated with MACE. The associations of neuropathy and hypercholesterolemia with MACE lessened over time, suggesting potential improvements in risk management or treatment strategies.