Numerous type 2 diabetes (T2DM) therapies that improve cardiovascular (CV) outcomes
are now available; however, there is limited data on their utilization following an
acute CV event. This study characterized the association between T2DM and adverse
CV events following a hospital admission for a major CV event and identified high-risk
patient subgroups who could benefit from further CV risk reduction with such therapies.
METHODS AND RESULTS
We conducted a population-based retrospective study using the Cardiovascular Health
in Ambulatory Care Research Team (CANHEART) registry of health services databases
in the province of Ontario, Canada. These datasets were linked using unique encoded
identifiers and analyzed at ICES. Patients were eligible if they were ≥18 years of
age and discharged alive from hospital between June 1, 2015 and March 31, 2019 with
a diagnosis of a major adverse CV event (defined as acute myocardial infarction [AMI],
hospitalization for heart failure [HHF], ischemic stroke, or peripheral arterial disease
[PAD]). The main exposure was the presence of T2DM at the time of index hospitalization.
Multivariate Cox models were adjusted for baseline sociodemographic and clinical comorbidities
to estimate hazard ratios (HR) associated between T2DM and the primary outcome (a
composite of all-cause death or recurrent AMI, HHF, ischemic stroke, or PAD). Among
the subset of patients ≥66 years of age who were eligible for universal drug coverage,
prescription patterns were determined following discharge. The cohort comprised 157,640
patients (T2DM: N=67,083; 42.6%; median age 72 years). After a median of 2 years of
follow up, the primary outcome occurred in 30,939 (46.1%) patients with T2DM compared
to 29,097 (32.1%) patients without T2DM (adjusted HR 1.28, 95% CI, 1.26-1.30, p <
0.0001). The presence of T2DM accounted for the greatest increase in risk in the primary
endpoint in patients admitted for PAD, followed by AMI, ischemic stroke, and HHF respectively
(Figure). In T2DM patients ≥66 years of age, uptake of guideline-directed medical
therapy increased from 100 days prior to hospitalization to 2 years of follow-up:
ACEi/ARB (66.0% to 75.6%), statin (64.8% to 82.7%), SGLT2i (4.7% to 15.3%), GLP1-RA
(previously not covered to 2.3%).
Patients with T2DM admitted for a major CV event have an adjusted 28% higher risk
of all-cause death or recurrent CV event compared with patients without diabetes.
This population is at high risk for recurrent events and would benefit from higher
implementation of evidence-based diabetes therapies with demonstrated CV protection.