Diabetes Complications and Comorbidities as Risk Factors for MACE in People With Type 2 Diabetes and Their Development Over Time: A Danish Registry-Based Case–Control Study

IF 3 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes Pub Date : 2025-03-26 DOI:10.1111/1753-0407.70076

Asger Ahlmann Bech, Mia Daugaard Madsen, Annika Vestergaard Kvist, Peter Vestergaard, Nicklas Højgaard-hessellund Rasmussen

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Abstract

Aim

This study aimed to investigate the association between cardiovascular risk factors and major adverse cardiovascular events (MACE) in people with type 2 diabetes, while assessing potential changes over time.

Methods

Utilizing data from Danish registries, this study identified people with type 2 diabetes between 2002 and 2021 (n = 372 328) and subdivided them into two 10-year time periods: TP1: 2002–2011 and TP2: 2012–2021, and further categorized into cases and controls. Cases were defined as having suffered a first-time three-point MACE (n_TP1 = 12 713, n_TP2 = 8981) and matched 1:1 with controls on age, sex, and type 2 diabetes duration. Exposures were preselected diabetes complications and comorbidities.

Results

Fewer were affected by MACE during TP2 compared to TP1 (p < 0.001). Diabetes complications associated with MACE were nephropathy (OR_TP1 = 1.54, 95% CI 1.30–1.83, OR_TP2 = 1.47, 95% CI 1.20–1.79), neuropathy (OR_TP1 = 2.02, 95% CI 1.84–2.21 OR_TP2 = 1.58, 95% CI 1.44–1.73) and retinopathy (OR_TP1 = 1.10, 95% CI 0.98–1.23, OR_TP2 = 1.38, 95% CI 1.17–1.63). Comorbidities associated with MACE included hypertension (OR_TP1 = 1.30, 95% CI 1.22–1.38 OR_TP2 = 1.31, 95% CI 1.22–1.41), atrial flutter or fibrillation (OR_TP1 = 1.46, 95% CI 1.35–1.58, OR_TP2 = 1.37, 95% CI 1.26–1.50), heart failure (OR_TP1 = 1.53, 95% CI 1.401.67-, OR_TP2 = 1.37, 95% CI 1.23–1.54) and hypercholesterolemia (OR_TP1 = 1.13, 95% CI 1.07–1.20, OR_TP2 = 1.02, 95% CI 0.96–1.10). Hypercholesterolemia (p = 0.038) and neuropathy (p = 0.038) exhibited a significant decrease in association with MACE between the time periods.

Conclusions

The prevalence of first-time MACE decreased over time, despite a relatively stable prevalence of type 2 diabetes. Several diabetes-related complications and comorbidities were significantly associated with MACE. The associations of neuropathy and hypercholesterolemia with MACE lessened over time, suggesting potential improvements in risk management or treatment strategies.

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糖尿病并发症和合并症是2型糖尿病患者MACE的危险因素及其长期发展：一项丹麦基于登记的病例对照研究

本研究旨在探讨2型糖尿病患者心血管危险因素与主要不良心血管事件（MACE）之间的关系，同时评估随时间推移的潜在变化。方法利用丹麦登记处的数据，本研究确定了2002年至2021年期间2型糖尿病患者（n = 372 328），并将其细分为两个10年时间段：TP1: 2002 - 2011年和TP2: 2012-2021年，并进一步分类为病例和对照组。病例定义为首次经历3点MACE (nTP1 = 12 713, nTP2 = 8981)，并在年龄、性别和2型糖尿病病程方面与对照组1:1匹配。暴露是预先选择的糖尿病并发症和合并症。结果与TP1相比，TP2期间MACE的影响较少（p < 0.001）。与MACE相关的糖尿病并发症为肾病（ORTP1 = 1.54, 95% CI 1.30-1.83, ORTP2 = 1.47, 95% CI 1.20-1.79）、神经病变（ORTP1 = 2.02, 95% CI 1.84-2.21, ORTP2 = 1.58, 95% CI 1.44-1.73）和视网膜病变（ORTP1 = 1.10, 95% CI 0.98-1.23, ORTP2 = 1.38, 95% CI 1.17-1.63）。与MACE相关的合并症包括高血压（ORTP1 = 1.30, 95% CI 1.22-1.38 ORTP2 = 1.31, 95% CI 1.22-1.41）、心房扑动或心房颤动（ORTP1 = 1.46, 95% CI 1.35-1.58, ORTP2 = 1.37, 95% CI 1.26-1.50）、心力衰竭（ORTP1 = 1.53, 95% CI 1.401.67-, ORTP2 = 1.37, 95% CI 1.23-1.54）和高胆固醇血症（ORTP1 = 1.13, 95% CI 1.07-1.20, ORTP2 = 1.02, 95% CI 0.96-1.10）。高胆固醇血症（p = 0.038）和神经病变（p = 0.038）与MACE之间的相关性显著降低。结论：尽管2型糖尿病的患病率相对稳定，但首次MACE的患病率随着时间的推移而下降。几种糖尿病相关并发症和合并症与MACE显著相关。神经病变和高胆固醇血症与MACE的相关性随着时间的推移而减弱，提示风险管理或治疗策略的潜在改进。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Diabetes ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

2.20%

发文量

审稿时长

>12 weeks

期刊介绍： Journal of Diabetes (JDB) devotes itself to diabetes research, therapeutics, and education. It aims to involve researchers and practitioners in a dialogue between East and West via all aspects of epidemiology, etiology, pathogenesis, management, complications and prevention of diabetes, including the molecular, biochemical, and physiological aspects of diabetes. The Editorial team is international with a unique mix of Asian and Western participation. The Editors welcome submissions in form of original research articles, images, novel case reports and correspondence, and will solicit reviews, point-counterpoint, commentaries, editorials, news highlights, and educational content.