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Abstract
We aimed to develop two models to estimate first AMI and stroke/TIA, respectively, in type 2 diabetes mellitus patients, by applying backward elimination to the following variables: age, sex, duration of diabetes, smoking, BMI, and use of antihyperglycemic drugs, statins, and aspirin. As time-varying covariates, we analyzed blood pressure, albuminuria, lipid profile, HbA1c, retinopathy, neuropathy, and atrial fibrillation (only in stroke/TIA model). Both models were stratified by antihypertensive drugs. We evaluated 2980 patients (52.8% women; 67.3 ± 11.2 years) with 24,159 person-years of follow-up. We recorded 114 cases of AMI and 185 cases of stroke/TIA. The factors that were independently associated with first AMI were age (≥ 75 years vs. < 75 years) (p = 0.019), higher HbA1c (> 64 mmol/mol vs. < 53 mmol/mol) (p = 0.003), HDL-cholesterol (0.90–1.81 mmol/L vs. < 0.90 mmol/L) (p = 0.002), and diastolic blood pressure (65–85 mmHg vs. < 65 mmHg) (p < 0.001). The factors that were independently associated with first stroke/TIA were age (≥ 75 years vs. < 60 years) (p < 0.001), atrial fibrillation (first year after the diagnosis vs. more than one year) (p = 0.001), glomerular filtration rate (per each 15 mL/min/1.73 m2 decrease) (p < 0.001), total cholesterol (3.88–6.46 mmol/L vs. < 3.88 mmol/L) (p < 0.001), triglycerides (per each increment of 1.13 mmol/L) (p = 0.031), albuminuria (p < 0.001), neuropathy (p = 0.01), and retinopathy (p = 0.023).
Highlights
Epidemiological studies have long sought to identify the clinical variables that contribute to incident cardiovascular events[1]
The present study reports data on the risk factors associated with the incidence of first acute myocardial infarction and stroke/transient ischemic attack (TIA) in a well-balanced Spanish type 2 diabetes cohort in terms of sex
We found incidence density rates of 4.72 cases/1000 person-years for first acute myocardial infarction and 7.66 cases/1000 person-years for first stroke or TIA in a primary care cohort of people with type-2 diabetes mellitus (T2DM) from a Mediterranean country who were free of cardiovascular events at baseline
Summary
Epidemiological studies have long sought to identify the clinical variables that contribute to incident cardiovascular events[1]. Factors in people with type-2 diabetes mellitus (T2DM) in a large representative outpatient cohort from southern Europe. Such data could add to global knowledge. Specific risk prediction tools for cardiovascular disease in people with T2DM have been developed[7,8] Another disadvantage of traditional epidemiological studies is that most cohorts are from the U.S and western Europe, with the result that cardiovascular risk estimation tools seem to perform differently depending on the ethnic, geographical, and social characteristics of the population in which they are used[9,10]. For an LDL cholesterol value close to 4 mmol/L, the risk of myocardial infarction increased by 50% (HR 1.50), while the risk for stroke barely reached 10%12, with 2.5 mmol/L as the reference category for these analyses
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