Aim To assess the potential gain in the number of life‐years free of a (recurrent) cardiovascular disease (CVD) event with optimal cardiovascular risk management (CVRM) and initiation of glucose‐lowering agents with proven cardiovascular benefit in people with type 2 diabetes (T2D). Materials and Methods 9,416 individuals with T2D from the CAPTURE study, a non‐interventional, cross‐sectional, multinational study, were included. The diabetes lifetime‐perspective prediction model was used for calculating individual 10‐year and lifetime CVD risk. The distribution of preventive medication use was assessed according to predicted CVD risk and stratified for history of CVD. For the estimation of absolute individual benefit from lifelong preventive treatment, including optimal CVRM and the addition of glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) and sodium‐glucose co‐transporter‐2 inhibitors (SGLT‐2is), the model was combined with treatment effects from current evidence. Results GLP‐1 RA or SGLT‐2i use did not greatly differ between patients with and without CVD history, while use of blood pressure‐lowering medication, statins and aspirin was more frequent in patients with CVD. Mean (standard deviation [SD]) lifetime benefit from optimal CVRM was 3.9 (3.0) and 1.3 (1.9) years in patients with and without established CVD, respectively. Further addition of a GLP‐1 RA and an SGLT‐2i in patients with CVD gave an added mean (SD) lifetime benefit of 1.2 (0.6) years. Conclusions Life‐years gained free of (recurrent) CVD by optimal CVRM and the addition of a GLP‐1 RA or aSGLT‐2i is dependent on baseline CVD status. These results aid individualizing prevention and promote shared decision‐making in patients with T2D.

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Introduction Cardiovascular disease (CVD) is the leading cause of mortality in people with type 2 diabetes (T2D). CAPTURE, a non-interventional, cross-sectional study conducted across 13 countries in 2019, collected demographic and clinical characteristics in almost 10,000 adults with T2D in primary or secondary care. Less than 25% of patients with established CVD treated with a glucose-lowering agent received an agent with demonstrated benefit in cardiovascular (CV) risk reduction, such as a glucagon-like peptide-1 receptor agonist (GLP-1 RA) or a sodium–glucose co-transporter-2 inhibitor (SGLT-2i).1 It is not known whether this is linked to estimated 10-year and lifetime CV risk. Purpose To estimate the CV risk distribution in the CAPTURE population using the Diabetes Lifetime-perspective prediction (DIAL) model, and to assess treatment patterns by CV risk. Methods The DIAL model is an externally validated competing risk adjusted model for predicting CV risk in patients with T2D, calculating absolute 10-year and lifetime risk of myocardial infarction, stroke or cardiovascular death, and life-expectancy free of a CVD event. Patient-level data from CAPTURE (age, sex, body mass index, smoking status, HbA1c, CVD history, T2D duration, clinical parameters and treatment history) were used in the DIAL model. Missing data were imputed by region using predicted mean matching. High risk was defined as 10-year risk >10%, and lifetime risk >50%. Results Data from 9457 patients with T2D aged 30–85 years were included in the analyses. There was a wide distribution of both 10-year and lifetime risk, with higher risk in patients with a history of CVD (n=2914) than in those without (n=6543). Among patients with a history of CVD, 96% had a 10-year risk of CVD >10% and 81% had a lifetime risk of CVD >50% (Figure). In patients with CVD and a high 10-year risk of recurrent CVD, 81% had a lifetime risk of recurrent CVD >50%. In patients without history of CVD, 14% had a 10-year risk >10% and only 1% had a lifetime risk >50% (Figure). Among patients without previous CVD but with a high 10-year risk of CVD, only 4% had a lifetime risk >50%. Of the patients with CVD, 10% received a GLP-1 RA and 18% received an SGLT-2i. Similarly, of patients with CVD and a high 10-year risk of recurrent CVD, 10% received a GLP-1 RA and 17% received an SGLT-2i. Among patients without CVD, 11% received a GLP-1 RA and 16% received an SGLT-2i, and among patients without current CVD but at a high 10-year risk of CVD, 12% received a GLP-1 RA and 16% received an SGLT-2i. Conclusion There is a wide distribution of CVD risk in the CAPTURE population, and only a minority of patients at high risk of CVD received a glucose-lowering agent with demonstrated benefit in CV risk reduction. Discussing with patients the 10-year and lifetime risks, and the CV benefit to be gained from interventions, can enhance shared decision making. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Funded by Novo Nordisk A/S