(22) Type 2 Diabetic Patients with a Single Cardiovascular or Renal Comorbidity: 5-Year Risk of a New Cardiovascular Renal Complication Using the French Nationwide Claims Database

Publication Number: 353

Background: Myocardial infarction (MI), stroke, peripheral arterial disease (PAD), heart failure (HF) and chronic kidney disease (CKD) are common cardiovascular renal disease (CVRD) complications for type 2 diabetes (T2D). The risk of the first complication is fairly well established for T2D patients while the risk of new CVRD complication for those with one of CVRD comorbidities is not well known.

Objectives: To assess CVRD and mortality risks for T2D patients with a single CVRD: MI, stroke, PAD, HF, CKD or cardiorenal disease (CRD=HF+CKD) compared to T2D patients without CVRD comorbidity.

Methods: A cohort study of all T2D patients without CVRD (disease-free) or with a single CVRD at baseline (January 1st, 2014) identified and followed-up for 5 years in the French SNDS nationwide claims database. Hazard ratios (HR [IC95%]) adjusted for sex and age were estimated using Fine and Gray competing risk model for clinical outcomes (MI, stroke, PAD, HF, CKD, CRD) and Cox proportional hazards risk model for all-cause mortality.

Results: From about 2 million T2D patients without cancer or transplantation at baseline, 76.5% were disease-free, 7.9% with a single CVRD and the others having several CVRD comorbidities history. Compared to the T2D disease-free population, the 5-year highest HR of each CVRD was observed in the corresponding comorbid CVRD population: 11.2 [11.0-11.5] for PAD, 8.8 [8.4-9.2] for CRD, 7.3 [7.2-7.4] for CKD, 5.0 [4.8-5.1] for HF, 3.3 [3.2-3.4] for stroke and 2.3 [2.1-2.5] for MI, in the PAD, CRD, CKD, HF, stroke and MI populations, respectively. HR were also high for CRD in CKD and HF populations (5.6 [5.5-5.7] and 3.3 [3.3-3.4], respectively), for CKD in CRD and HF populations (9.8 [9.4-10.2], 7.6 [7.3-8.0] and 2.4 [2.3-2.5], respectively), for HF in CRD and CKD populations (7.6 [7.3-8.0] and 2.3 [2.3-2.4], respectively), for PAD in CRD and CKD populations ([3.7 [3.4-4.1] and 2.9 [2.8-3.0], respectively), while all other HR were also statistically significant but with a point estimate ≤ 2.0. The HR of all-cause death was 4.3 [4.2-4.5] for CRD, 2.7 [2.7-2.8] for HF, 2.1 [2.0-2.1] for CKD, 2.1 [2.0-2.1] for PAD, 1.9 [1.9-1.9] for stroke and 1.4 [1.3-1.4] for MI populations.

Conclusions: For T2D patients with a single CVRD complication compared to T2D patients of same age and sex without CVRD comorbidity, the risk of subsequent event is high, especially for PAD, CRD, CKD, HF and to a lesser extent, stroke and MI populations. It was associated with an increased risk of death of about 4 times higher for CRD patients, about 3 for HF patients and about 2 for CKD, PAD and stroke patients.