All-cause mortality and cardiovascular events in a Spanish nonagenarian cohort according to type 2 diabetes mellitus status and established cardiovascular disease

Abstract

Background Despite the progressive aging of the population in industrialized countries, few studies have focused on the natural history of cardiovascular disease in the very old, and recommendations on prevention of cardiovascular disease in this population are lacking. We aimed to analyze all-cause mortality and cardiovascular events according to prevalent type 2 diabetes mellitus and established cardiovascular disease in nonagenarians from a Mediterranean population. Methods We analyzed the primary health records of all nonagenarians living in the Community of Madrid (N = 59,423) and collected data for 4 groups: Group 1, individuals without T2DM or established CVD (T2DM-, CVD-); Group 2, individuals without T2DM but with established CVD (T2DM-, CVD +); Group 3, individuals with T2DM but without established CVD (T2DM + , CVD-); and Group 4, individuals with both T2DM and established CVD (T2DM + , CVD +), taking into account the influence of sex on the outcomes. Follow-up was 2.5 years. The primary outcomes were cumulative incidence and incidence density rates for all-cause mortality, non-fatal myocardial infarction, non-fatal stroke (the first composite primary outcome [CPO1]), combined with heart failure (CPO2). We evaluated the adjusted effect of each group on all-cause mortality (Cox regression). Results Mean age was 93.3 ± 2.8 years (74.2% women). Hypertension, dyslipidemia, heart failure, albuminuria, and estimated glomerular filtration rate < 60 mL/min/1.73 m2 were significantly more prevalent in G4 than in the other groups (all p values < 0.001). We observed significantly higher cumulative incidence rates for all-cause mortality, CPO1, and CPO2 in participants belonging to G4 (all p values ≤ 0.001). People in G2 presented higher rates of all-cause mortality, heart failure, CPO1, and CPO2 than people in G3 (all p values ≤ 0.001). In the fully adjusted model, G4 independently predicted all-cause mortality (HR = 1.48 [95% CI, 1.40 to 1.57] vs reference G1 [p < 0.01]). In addition, significant HRs were recorded for cardiovascular disease alone (G2) and type 2 diabetes mellitus alone (G3) (1.13 and 1.14, respectively; both p values < 0.01). Conclusions In Spanish nonagenarians, established cardiovascular disease and type 2 diabetes mellitus conferred a modest risk of all-cause mortality. However, the simultaneous presence of both conditions conferred the highest risk of all-cause mortality.

Cardiovascular disease and type 2 diabetes in older adults: a combined protocol for an individual participant data analysis for risk prediction and a network meta-analysis of novel anti-diabetic drugs

“…A potential non-linear relationship for continuous variables such as HbA1c will be accounted for by including splines in the model. In order to determine if T2D is a coronary risk equivalent among multimorbid older adults, we will compare the risk of CVD events and death of non-diabetic adults who had a previous CHD event to that of diabetic adults with no prior CHD [12].…”

“…Two large contemporary studies found a lower risk of developing CHD in diabetics without prior CHD compared to non-diabetics with previous CHD [10, 11]. Yet, two studies that were conducted exclusively in older adults reported a similar risk of CVD across these two groups, supporting the status of diabetes as a coronary risk equivalent in this population [12, 13].…”

Effect of glucose variability on the mortality of adults aged 75 years and over during the first year of the COVID-19 pandemic

“…We have validated the quality of the EHRs in primary care for research use [19][20][21], and the database has been widely employed to study the epidemiology of cardiovascular risk factors in older patients [22].…”

Classification rule for ten year MACE Risk in Primary Care Tarragona Older Adults with type2 Diabetes. A CHAID decision-tree analysis.

“…In fact, to resolve this limitation, the 2021 ESC guidelines on cardiovascular disease prevention in clinical practice, introduce the new SCORE2-OP to estimate 10 year risk of CVD death and CVD morbidity (nonfatal myocardial infarction, non-fatal stroke) for people between 70 and 89 years [11]. More speci cally, few studies have focused on the natural history of CVD in the very old population, since frail older people are usually excluded from randomized controlled trials [12][13][14].…”