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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

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 Thumbnail


Authors

Bingjie Qu

Uchechukwu Levi Osuagwu

Karen Pickering

John Baker

Richard Cutfield MBChB

Richard Cutfield

Yamei Cai

Brandon J Orr-Walker

Gerhard Sundborn

Zhanzheng Zhao

David Simmons



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.

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.

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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 (4.4 Mb)
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Copyright Statement
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.





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