P4449Incident cardiovascular disease in patients with type 2 diabetes: Established cardiovascular disease versus traditional risk markers
Authors: Jensen J , Schou M , Kistorp C , Faber J , Hansen T W , Jensen M T , Andersen H U , Rossing P , Vilsboll T , Jorgensen P G 
Published: October 2019

Abstract

Background/Introduction
It is well established that patients with both T2D and established cardiovascular disease (CVD) are at high-risk of a re-event and should be treated with either a glucagon-like peptide-1 (GLP-1) analogue or a sodium-glucose transporter-2 (SGLT-2) inhibitor. Other high-risk patients with T2D may also benefit from these treatments. Whether traditional risk markers can identify patients with T2D without CVD with a similar incidence of CVD events as patients with T2D with established CVD is unknown.

Purpose
To compare the CVD incidence in patients with T2D with and without established CVD, stratified according to mid-regional pro-atrial natriuretic peptide (MR-proANP), albuminuria, electrogardiogram (ECG), echocardiography and age, to identify patients without established CVD who are at high risk of a CVD event.

Methods
In this prospective cohort study, patients with T2D (n=921) from a specialized diabetes clinic were examined at baseline regarding the different risk markers. Increasing cut-offs for MR-proANP were analysed to identify high-risk patients. Albuminuria included both micro- and macroalbuminuria. An abnormal ECG was defined as the presence of ST-/T-changes, bundle branch block or atrial fibrillation, and an abnormal echocardiography was defined as either heart failure with preserved (HFpEF) or reduced (HFrEF) ejection fraction. Established CVD was reported at baseline as prior myocardial infarction, coronary revascularization, cerebrovascular disease or peripheral artery disease. Information regarding CVD events was retrieved through national registers and a CVD event was similarly defined as established CVD, but in addition also included hospitalisation for heart failure and CVD death.

Results
In total, 224 (24%) patients had established CVD at baseline. Median [interquartile range] of follow-up was 4.7 [4.0–5.3] years. The incidence of CVD events among patients with established CVD was 95.7 per 1000-person years. Using a cut-off for MR-proANP of 190 pmol/l revealed that patients with a value above had similar incidence (93.9 per 1000-person years) and was found in 47 of 697 (6.7%) patients without CVD. In contrast, patients without CVD and with albuminuria (146 of 685 (21.3%) patients) or abnormal ECG (147 of 679 (21.6%)) or abnormal echocardiography (221 of 618 (35.7%)) or an age>65 years (335 of 697 (35.7%)) had substantial lower incidence (47.1, 35.1, 32.7 and 33.7 per 1000-person years, respectively).
Kaplan-Meier curves

Conclusion(s)
In patients with T2D without established CVD, using a range of traditional risk markers, we were only able to identify a subgroup of patients with MR-proANP values above 190 pmol/l who had a similar high incidence of CVD as T2D patients with established CVD. This subgroup may benefit from treatment with a GLP-1 analog or a SGLT-2 inhibitor. In contrast, the presence of other traditional risk markers in T2D was not associated with risk of incident CVD similar to patients with established CVD.

Acknowledgement/Funding
Thermo Fisher Scientific (Germany) funded the MR-proANP kits