Results of a new study out of New Zealand show that many diabetics have normal renal function, are not controlling their blood glucose pharmacologically, and are at low risk for cardiovascular disease.
International guidelines consider people with diabetes to be at high risk for subsequent cardiovascular disease. Consequently, treatment with glucose-lowering medications is often recommended, with the goal of preventing cardiovascular complications. The New Zealand Disease Cohort Study (NZDCS) prediction tool was developed between 2000 and 2006 to predict cardiovascular disease in people with diabetes. The resulting equation predicted rates of cardiovascular disease of 14.2% in women and 17.1% in men with diabetes.
Risk factors lowered with increased diabetes screening
In 2003, New Zealand began to increase screening for diabetes across its population. Only 15% of the population was screened in 2001; this number went up to 50% in 2012, and 90% in 2016. Researchers tracked first cardiovascular events in 46,652 newly diagnosed diabetics for a median follow-up of 5.2 years. Significantly, 14,829 (31.8%) were not taking oral hypoglycemic medications or insulin at baseline.
Researchers next used Cox regression models to develop sex-specific equations to estimate the 5-year risk of cardiovascular disease. They used 18 prespecified predictors of cardiovascular disease in their models, including diabetes-related and renal function measures. Significant predictors of adverse cardiac events included age, ethnicity, duration of diabetes, smoking, socioeconomic status; levels of glycated hemoglobin, blood pressure, cholesterol levels. Comparing their data to the pre-existing NZDCS tool, researchers showed that the NZDCS tool had significantly over-predicted rates of cardiovascular disease – by 3 times in women, and two times in men. The median 5-year cardiovascular risk estimated by the adapted model was 4.0% in women and 7.1% in men with diabetes.
Stratify diabetics into high and low risk
Researchers concluded that the risk of cardiovascular disease in diabetics is much lower than previously thought. Going forward, predictive models should stratify diabetics into high- and low-risk categories for cardiovascular disease. This differentiation will allow for appropriate clinical decision-making regarding the most cost-effective and least invasive management of patients with diabetes.
Author: Kelly Schoonderwoerd
Original article: Pylypchuk R et al. Lancet 2021 Jun 12; 397(10291): 2264-2274.