Cardiorenal Disease is the Costliest CVD in Type 2 Diabetes: A Large Long-Term Observational Study

Abstract

Introduction: Cardiorenal disease (heart failure [HF] or chronic kidney disease [CKD]) has recently been shown to be the most common first T2D CVD manifestation, associated with high mortality risks. The aim was to describe the development of cardiorenal- and cardiovascular disease (CVD) health care costs. Methods: T2D patients without prior CVD and cardiorenal disease, defined as CVD free, were identified in full-population health care registries in Sweden and indexed 1st January 2007. Mean health care cost per patient was summed cumulatively over 10-years for first and recurring events of: stroke, myocardial infarction (MI), peripheral artery disease (PAD) and cardiorenal disease. Results: From 229,033 patients; 137,738 (60%) were CVD free, and followed for mean 7.7 years, 1.1 million patient-years. Cardiorenal disease was the most common CV manifestation (47.7%), followed by stroke (22.7%), MI (19.6%) and PAD (10.0%). HF and CKD were separately 24.0% and 23.7% respectively. In CVD free T2D patients, health care costs for cardiorenal disease was the highest already within the first year. In the total population, CVD costs incurred health care costs of ~$1 billion (mean $7008 per patient) of which cardiorenal disease was the costliest (60.5%), followed by stroke (16.8%), MI (13.6%) and PAD (9.1%). HF and CKD were separately 30.5 and 30.0% respectively. Conclusion: In CVD free T2D patients, cardiorenal diseases incurred the highest short and long-term health care costs compared to stroke, MI and PAD. These data highlight the total health care burden of cardiorenal complications and the urgent need of preventive efforts.