Abstract 50: Cardiovascular Event Rates Among Adults with Type 2 Diabetes Mellitus at Risk of Cardiovascular Events in the Large Population-based Study to Help Improve Early Evaluation and Management of Risk Factors Leading to Diabetes (SHIELD)

Abstract

Objectives: This study ascertained the incidence and time to first non-fatal myocardial infarction (MI), stroke, heart bypass surgery, or angioplasty among adults with type 2 diabetes mellitus (T2DM) at high risk for cardiovascular disease (CVD) over 3 and 5 years using a large US population based study. Methods: A retrospective cohort study used data from the US population-based SHIELD, a 5-year prospective survey-based study of adults with and without T2DM. Respondents with T2DM were stratified into 2 cohorts: (1) established CVD cohort, with age ≥40 years, prior MI, prior stroke, atherosclerosis, or peripheral vascular disease, and (2) multiple risk factors cohort (men ≥55 years and women ≥60 years and ≥1 risk factors of hyperlipidemia, hypertension, currently smoking, without prior history of CVD). Proportion of respondents self-reporting a new MI, stroke, angioplasty, or heart bypass surgery was calculated and multivariate discrete logistic hazards models for 3 and 5 years of follow-up were developed. Results: Among 2122 T2DM respondents, 56.5% had established CVD (mean age = 65 years, 45% male); 43.5% had no established CVD but multiple risk factors (mean age = 68 years, 49% male). The established CVD cohort had a new MI, stroke, or revascularization event rate of 26.3% during a 3 year follow-up period and 31.2% during the 5 years of follow-up. For the multiple risk factors cohort, 18.8% within 3 years and 26.0% within 5 years had an incident MI, stroke, or revascularization. After adjusting for gender, age, obesity, duration of diabetes, and comorbidities, the risk of incident MI was 2.1 times higher (95% CI: 1.6-2.8) within 3 years and 1.9 times higher (1.5-2.4) within 5 years of follow-up among the established CVD cohort than multiple risk factors cohort (p<0.001). Risk of incident stroke was 2.2 (1.4-3.5) and 1.8 (1.2-2.7) times higher within 3 and 5 years, respectively, after adjustment among the established CVD cohort than multiple risk factors cohort (p <0.01). Risk of incident heart bypass surgery was 2.6 (1.7-4.2) and 2.5 (1.7-3.8) times higher, and risk of incident angioplasty was 3.9 (2.7-5.9) and 3.2 (2.3-4.5) times higher within 3 and 5 years, respectively, among the established CVD cohort than multiple risk factors cohort (p <0.001). Conclusions: T2DM individuals at risk for CVD events had significant incidence of MI, stroke, and revascularization in this large US population-based study. T2DM adults with established CVD are at higher risk of CVD events than those with no CVD but have multiple risk factors.