Abstract
ObjectivesTo investigate early and long-term outcomes after treatment of carotid artery stenosis in patients with type 2 diabetes (T2D) compared to patients without T2D.Design/methodThis observational nationwide population-based retrospective cohort study investigated all T2D patients treated for carotid stenosis registered in the National Swedish Vascular Surgery and the National Diabetes Registries. Data was collected prospectively for all patients after carotid intervention, during 2009–2015. We estimated crude early (within 30-days) hazard ratios (HRs) risk of stroke and death, and long-term HRs risk, adjusted for confounders with 95% confidence intervals (CIs), for stroke and death and major adverse cardiovascular events (MACE) by using inverse probability of treatment weighting matching.ResultsA total of 1341 patients with T2D and 4162 patients without T2D were included; 89% treated for symptomatic carotid stenosis, 96% with carotid endarterectomy. There was an increased early risk, HRs (95% CI), for stroke in T2D patients 1.65 (1.17–2.32), whereas risk for early death 1.00 (0.49–2.04) was similar in both groups. During a median follow-up of 4.3 (T2D) and 4.6 (without T2D), with a maximum of 8.0 years; after propensity score matching there was an increased HRs (95% CI) of stroke 1.27 (1.05–1.54) and death 1.27 (1.10–1.47) in T2D patients compared to patients without T2D. Corresponding numbers for MACE were 1.21 (1.08–1.35).ConclusionsPatients with T2D run an increased risk for stroke, death, and MACE after carotid intervention. They also have an increased perioperative risk for stroke, but not for death.
Highlights
The prevalence of diabetes has increased dramatically the past decades all over the world, and type 2 diabetes (T2D) accounts for the majority of the cases
A total of 1341 patients with T2D and 4162 patients without T2D were included; 89% treated for sympto‐ matic carotid stenosis, 96% with carotid endarterectomy
During a median follow-up of 4.3 (T2D) and 4.6, with a maximum of 8.0 years; after propensity score matching there was an increased Hazard ratio (HR) of stroke 1.27 (1.05–1.54) and death 1.27 (1.10–1.47) in T2D patients compared to patients without T2D
Summary
The prevalence of diabetes has increased dramatically the past decades all over the world, and type 2 diabetes (T2D) accounts for the majority of the cases. T2D has been associated with an increased risk of cardiovascular complications [1]. People with T2D have more than a 50% relative higher risk for stroke compared to those without diabetes [2]. Stroke represents a heterogeneous group of vascular pathologies where risk factors, such as hypertension, atrial fibrillation, smoking, hyperlipidemia and carotid stenosis, contribute to the increased risk. Carotid stenosis accounts for approximately 10–15% of all ischemic strokes [3]. Ever since the landmark studies, i.e. the North American Symptomatic Carotid Endarterectomy Trial (NASCET) [4] and the European Carotid Surgery Trial (ECST) [5], carotid endarterectomy has been a cornerstone in reducing the risk of stroke in patients with symptomatic carotid stenosis
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