A study analyzing data from the Veradigm Metabolic Registry between 2017 and 2022 found that patients with type 1 diabetes may have a lower risk of experiencing cardiovascular events compared with those with type 2 diabetes, a trend observed across multiple cardiovascular conditions.
In the study, published in the Journal of the Society for Cardiovascular Angiography & Interventions, investigators assessed 162,027 patients, including 5,823 with type 1 diabetes mellitus (DM1) and 156,204 with type 2 diabetes mellitus (DM2), across 758,643 outpatient visits at 97 U.S. facilities. The study reported 11,096 incident cardiovascular events, with DM1 patients experiencing a lower overall event rate (0.92%) compared to DM2 patients (1.49%). The unadjusted prevalence ratio (PR) for cardiovascular events in DM1 was 0.63 (95% confidence interval [CI] = 0.55–0.71), and after adjusting for age, the PR remained lower at 0.66 (95% CI = 0.58–0.74).
Among specific cardiovascular events, patients with DM1 had a lower prevalence of myocardial infarction (PR = 0.56), percutaneous coronary intervention (PCI) (PR = 0.43), stroke (PR = 0.64), and limb ischemia (PR = 0.57), while rates of coronary artery bypass grafting (CABG), carotid revascularization, and peripheral revascularization were similar between patients with DM1 and DM2.
Patients with DM1 were younger (mean age = 59.4 years vs 62.7 years for DM2) and had fewer comorbidities, including coronary artery disease (7.6% vs 11.8%), hypertension (51.2% vs 78.9%), and dyslipidemia (66.7% vs 72.3%). Their mean body mass index was lower (28.4 kg/m² vs 33.8 kg/m²), and they were predominantly treated in endocrinology clinics (90.1%).
The investigators also examined whether the COVID-19 pandemic influenced cardiovascular event rates but found no statistically significant difference before and after March 2020.
"Among [Veradigm Metabolic Registry patients with diabetes] without a history of cardiovascular events receiving care at facilities with primary care and/or endocrinology, DM1 was associated with a lower probability of incident cardiovascular events than DM2," noted lead study author Andrew M. Goldsweig, MD, of the Department of Cardiovascular Medicine at the Baystate Medical Center, and colleagues. "[T]hese findings were consistent across multiple types of cardiovascular events, ages 46 [to] 75, sex, calendar quarter, comorbidities, and after adjustment for HbA1c," they added.
The mechanisms behind this difference remained unclear, and further research may be needed to determine distinct cardiovascular risks, prevention strategies, and treatment options among patients with DM1. The investigators acknowledged that registry-based data have limitations, including missing patient history details and potential selection biases. Despite these constraints, the study was one of the most comprehensive comparisons of cardiovascular risks in DM1 vs DM2 in a U.S. outpatient population.
The findings suggested that patients with DM1 may have a lower overall risk of cardiovascular events compared with DM2. However, additional studies may be required to determine the underlying pathophysiologic differences and optimize cardiovascular risk management in patients with DM1.
The authors reported no competing interests.