Cardiovascular events and mortality in people with and without type 2 diabetes: An observational study in a contemporary multi-ethnic population.
AIMS/INTRODUCTION
The aim of this study was to examine ethnicity-specific associations between type 2 diabetes mellitus and the 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 type 2 diabetes mellitus diagnosed 2000-2006. The outcome was the first CVD event during 2007-2017 and the following 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.


RESULTS
A total of 734,543 people with and without type 2 diabetes mellitus (29,847; 4.1%) were included; most were of white ethnicity (93.0% with and 92.3% without type 2 diabetes mellitus) followed by South Asian (3.2 and 4.6%). During a median follow-up period of 11.0 years, 67,218 events occurred (6,156 in individuals with type 2 diabetes mellitus). Type 2 diabetes mellitus was associated with a small increase in CVD events (adjusted hazard ratio 1.06, 95% confidence interval 1.02-1.09) in individuals of white ethnicity; whereas the adjusted hazard ratios were considerably higher in individuals of South Asian ethnicity (1.28, 95% confidence interval 1.09-1.51), primarily due to an increased risk of myocardial infarction (1.53, 95% confidence interval 1.08-2.18).


CONCLUSIONS
Despite universal access to healthcare, there are large disparities in CVD outcomes in people with and without type 2 diabetes mellitus. Other non-traditional risk factors might play a role in the higher CVD risk associated with type 2 diabetes mellitus in individuals of South Asian ethnicity.
['Coles|Briana|B|https://orcid.org/0000-0003-4228-8818', 'Zaccardi|Francesco|F|', 'Ling|Suping|S|', 'Davies|Melanie J|MJ|', 'Samani|Nilesh J|NJ|', 'Khunti|Kamlesh|K|']
D000328:Adult D000368:Aged D001210:Asia, Southeastern D044466:Asians D044383:Blacks D002318:Cardiovascular Diseases D003924:Diabetes Mellitus, Type 2 D004739:England D005006:Ethnicity D005260:Female D054624:Health Status Disparities D000082742:Heart Disease Risk Factors D006801:Humans D008297:Male D008875:Middle Aged D010641:Phenotype D016016:Proportional Hazards Models D012189:Retrospective Studies D044465:Whites
Risk factors Ethnic groups Type 2 diabetes