Effect of onset of type 2 diabetes on risks of cardiovascular disease and heart failure among new Zealanders with impaired glucose tolerance over 25 years: tapered-matched landmark analysis

Yu, Dahai; Qu, Bingjie; Levi Osuagwu, Uchechukwu; Pickering, Karen; Baker, John; Cutfield MBChB, Richard; Cutfield, Richard; Cai, Yamei; J Orr-Walker, Brandon; Sundborn, Gerhard; Zhao, Zhanzheng; Simmons, David

Abstract

Background
This study aimed to examine the association between the incident onset of T2DM and 5- and 10-year risks of CVD and HF in people with IGT identified in primary care in South and West Auckland, New Zealand (NZ) between 1994 and 2019.

Methods
We compared CVD and HF risks in patients with IGT and with/without T2D newly diagnosed within the exposure window (1–5 years). Tapered matching and landmark analysis (to account for immortal bias) were used to control for potential effects of known confounders.

Results
Among 26,794 patients enrolled with IGT, 845 had T2D newly diagnosed within 5 years from enrolment (landmark date) and 15,452 did not have T2D diagnosed. Patients progressing to T2D (vs. those not progressing) had a similar 5-year risk for CVD (hazard ratio 1.19; 95% CI 0.61–2.32) but significantly higher 10-year risk of CVD (2.45(1.40–4.29)), 5-year risk of HF (1.94(1.20–3.12)) and 10-year risk of HF (2.84(1.83–4.39). The association between the onset of T2D and risk of 10-year risk of CVD, 5-year and 10-year risk of HF was more likely among men, the socioeconomically deprived, those currently smoking, patients with higher metabolic measures and/or those with lower renal function. Patients of NZ European ethnicity had a lower 10-year risk of CVD.

Conclusions
The study suggests that the diagnosis of T2D mediates the risk of CVD and HF in people with IGT. The development of risk scores to identify and better manage individuals with IGT at high risk of T2D is warranted.

Citation

Yu, D., Qu, B., Levi Osuagwu, U., Pickering, K., Baker, J., Cutfield MBChB, R., …Simmons, D. (2023). Effect of onset of type 2 diabetes on risks of cardiovascular disease and heart failure among new Zealanders with impaired glucose tolerance over 25 years: tapered-matched landmark analysis. Cardiovascular Diabetology, 22(1), Article 163. https://doi.org/10.1186/s12933-023-01871-y

• Journal Article Type: Article
• Acceptance Date: May 29, 2023
• Online Publication Date: Jun 30, 2023
• Publication Date: Jun 30, 2023
• Deposit Date: Jul 4, 2023
• Publicly Available Date: Jul 4, 2023
• Journal: Cardiovascular Diabetology
• Electronic ISSN: 1475-2840
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 22
• Issue: 1
• Article Number: 163
• DOI: https://doi.org/10.1186/s12933-023-01871-y
• Keywords: Impaired glucose tolerance, Cardiovascular diseases, Heart failure, Type 2 diabetes, Landmark analysis, Tapered matching
• Additional Information: Received: 21 April 2023; Accepted: 29 May 2023; First Online: 30 June 2023; : ; : The North Health Ethics Committee approved the DCSS for research purposes in 1992, and then as an ongoing audit in 1996 (92/006). Approval for waiver of individual informed consent and approval for study was provided by the New Zealand Health Disability Ethics Committee on March 25, 2019. Anonymised data were used for this analysis and all methods were carried out in accordance with relevant guidelines and regulations.; : Not Applicable.; : The authors declare no competing interests.