Cardiovascular events and mortality in people with and without type 2 diabetes: An observational study in a contemporary multi-ethnic population.

Aims

Examine ethnicity‐specific associations between type 2 diabetes (T2DM) and risk of a cardiovascular disease (CVD) event as well as risk of specific CVD phenotypes in England.

Methods

We obtained data from the Clinical Practice Research Datalink for adults with and without T2DM diagnosed 2000‐2006. The outcome was the first CVD event during 2007‐2017 and components: aortic aneurysm, cerebrovascular accidents, heart failure, myocardial infarction, peripheral vascular disease, and other CVD‐related conditions. Flexible parametric survival models were used to estimate ethnicity‐specific adjusted hazard ratios (aHR).

Results

734,543 people with and without T2DM (29,847; 4.1%) were included; most were of White ethnicity (93.0% with and 92.3% without T2DM) followed by South Asian (3.2% and 4.6%). During a median follow‐up of 11.0 years, 67,218 events occurred (6,156 in individuals with T2DM). T2DM was associated with a small increase in CVD events (aHR: 1.06; 95% CI: 1.02, 1.09) in individuals of White ethnicity; while the aHR was considerably higher in South Asians (1.28; 1.09, 1.51), primarily due to an increased risk of myocardial infarction (1.53; 1.08, 2.18).

Conclusions

Despite universal access to healthcare, there are large disparities in CVD outcomes in people with and without T2DM. Other, non‐traditional risk factors may play a role in the higher CVD risk associated with T2DM in South Asians.