Cardiovascular Event Prevalence in Type 1 Versus Type 2 Diabetes: Veradigm Metabolic Registry Insights

Journal of the Society for Cardiovascular Angiography & Interventions Pub Date : 2025-03-01 DOI:10.1016/j.jscai.2024.102502

Andrew M. Goldsweig MD, MS , Alexander Knee MS , Hyo Jung Tak PhD , Nihar R. Desai MD, MPH , Steven M. Bradley MD, MPH , Amir S. Lotfi MD , John A. Spertus MD, MPH , Bracha K. Goldsweig MD

{"title":"Cardiovascular Event Prevalence in Type 1 Versus Type 2 Diabetes: Veradigm Metabolic Registry Insights","authors":"Andrew M. Goldsweig MD, MS , Alexander Knee MS , Hyo Jung Tak PhD , Nihar R. Desai MD, MPH , Steven M. Bradley MD, MPH , Amir S. Lotfi MD , John A. Spertus MD, MPH , Bracha K. Goldsweig MD","doi":"10.1016/j.jscai.2024.102502","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Diabetes mellitus type 1 (DM1) and type 2 (DM2) are well-established risk factors for cardiovascular disease but differ pathophysiologically in that DM1 results from insulin deficiency, whereas DM2 results from insulin insensitivity. The association between DM1 and DM2 and cardiovascular events remains undetermined.</div></div><div><h3>Methods</h3><div>For DM1 or DM2 patients aged 46 to 75 years receiving care at outpatient facilities with primary care and/or endocrinology enrolled in the National Cardiovascular Data Registry Veradigm Metabolic Registry 2017-2022, we compared the prevalence of incident cardiovascular events including myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, stroke, carotid revascularization, limb ischemia, and peripheral revascularization.</div></div><div><h3>Results</h3><div>The study population included 5823 DM1 patients (3.59%) and 156,204 DM2 patients (95.41%) with a total of 758,643 visits. DM1 patients were younger and had fewer comorbidities. A total of 11,096 incident cardiovascular events occurred with a prevalence ratio (PR) of 0.63 (95% CI, 0.55-0.71) for fewer events associated with DM1 than DM2. After adjustment for age, the PR was 0.66 (95% CI, 0.58-0.74). When analyzed by separate cardiovascular events, DM1 was associated with less myocardial infarction, percutaneous coronary intervention, stroke, and limb ischemia than DM2. Overall cardiovascular event probability was lower in DM1 than in DM2 across all 10-year age categories, in both female and male patients, before and during/after the coronavirus disease 2019 pandemic, and after adjustment for comorbidities, hemoglobin A1c, and serum creatinine.</div></div><div><h3>Conclusions</h3><div>DM1 was associated with a lower probability of incident cardiovascular events than DM2. Although DM1 may carry a lower risk of incident cardiovascular events than DM2, the pathophysiology, prevention, and treatment of cardiovascular disease in DM1 remain poorly understood.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"4 3","pages":"Article 102502"},"PeriodicalIF":0.0000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the Society for Cardiovascular Angiography & Interventions","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2772930324021914","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Diabetes mellitus type 1 (DM1) and type 2 (DM2) are well-established risk factors for cardiovascular disease but differ pathophysiologically in that DM1 results from insulin deficiency, whereas DM2 results from insulin insensitivity. The association between DM1 and DM2 and cardiovascular events remains undetermined.

Methods

For DM1 or DM2 patients aged 46 to 75 years receiving care at outpatient facilities with primary care and/or endocrinology enrolled in the National Cardiovascular Data Registry Veradigm Metabolic Registry 2017-2022, we compared the prevalence of incident cardiovascular events including myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, stroke, carotid revascularization, limb ischemia, and peripheral revascularization.

Results

The study population included 5823 DM1 patients (3.59%) and 156,204 DM2 patients (95.41%) with a total of 758,643 visits. DM1 patients were younger and had fewer comorbidities. A total of 11,096 incident cardiovascular events occurred with a prevalence ratio (PR) of 0.63 (95% CI, 0.55-0.71) for fewer events associated with DM1 than DM2. After adjustment for age, the PR was 0.66 (95% CI, 0.58-0.74). When analyzed by separate cardiovascular events, DM1 was associated with less myocardial infarction, percutaneous coronary intervention, stroke, and limb ischemia than DM2. Overall cardiovascular event probability was lower in DM1 than in DM2 across all 10-year age categories, in both female and male patients, before and during/after the coronavirus disease 2019 pandemic, and after adjustment for comorbidities, hemoglobin A1c, and serum creatinine.

Conclusions

DM1 was associated with a lower probability of incident cardiovascular events than DM2. Although DM1 may carry a lower risk of incident cardiovascular events than DM2, the pathophysiology, prevention, and treatment of cardiovascular disease in DM1 remain poorly understood.

查看原文本刊更多论文

背景1型糖尿病（DM1）和2型糖尿病（DM2）是心血管疾病的公认危险因素，但在病理生理学上有所不同，DM1是由于胰岛素缺乏引起的，而DM2是由于胰岛素不敏感引起的。DM1和DM2与心血管事件之间的关系仍未确定。方法对于在门诊机构接受初级保健和/或内分泌科治疗的 46 至 75 岁的 DM1 或 DM2 患者，我们比较了心血管事件的发生率，包括心肌梗死、经皮冠状动脉介入治疗、冠状动脉旁路移植术、中风、颈动脉血运重建、肢体缺血和外周血管血运重建。结果研究对象包括5823名DM1患者（3.59%）和156204名DM2患者（95.41%），共就诊758643次。DM1 患者更年轻，合并症更少。共发生了 11,096 例心血管事件，DM1 患者比 DM2 患者发生的事件少，患病率比 (PR) 为 0.63（95% CI，0.55-0.71）。根据年龄进行调整后，患病率比为 0.66（95% CI，0.58-0.74）。如果按单独的心血管事件进行分析，DM1 与心肌梗死、经皮冠状动脉介入治疗、中风和肢体缺血相关的事件少于 DM2。在所有10岁年龄组中，在女性和男性患者中，在2019年冠状病毒疾病大流行之前和期间/之后，以及在对合并症、血红蛋白A1c和血清肌酐进行调整后，DM1的总体心血管事件概率均低于DM2。尽管DM1发生心血管事件的风险可能低于DM2，但人们对DM1心血管疾病的病理生理学、预防和治疗仍知之甚少。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊