Cardiovascular risk profiles in Type 2 diabetes and the impact of geographical setting

Abstract

Cardiovascular (CV) disease is a leading morbidity and mortality in Type 2 diabetes (T2DM). Previous studies have shown geographic differences in the prevalence of CV and renal diseases. A literature review of longitudinal (≥5 years) studies including ≥1000 T2DM patients and reporting CV endpoints was performed to compare risk profiles. Key differences between geographies included a relatively higher prevalence of microalbuminuria in East Asian relative to North American and European patients, which in turn is an important CV risk factor. Patients from East Asia also have a relatively higher incidence of stroke and lower incidence of coronary heart disease. Overall, there are differences in CV risk in T2DM patients between different regions and that long-term studies from Africa, the Middle East and Latin America are lacking.

Keywords:

• burden
• cardiovascular disease
• dyslipidemia
• glycemic control
• hypertension
• obesity
• Type 2 diabetes

Acknowledgements

Part of this work has been submitted in abstract form to the 17th Annual European Congress of the International Society for Pharmacoeconomics and Outcomes Research. J Smith-Palmer, JP Bae, KS Boye, M Perez-Nieves, W Valentine. Traditional And Non-Traditional Risk Factors For Cardiovascular Disease In Type 2 Diabetes: Systematic Review Of Longitudinal Studies. VALUE IN HEALTH 17 A 3 2 3 – A 6 8 6 (2 0 1 4).

Financial & competing interests disclosure

J Bae, M Perez-Nieves and K Boye are current employees of Eli Lilly and Company, which provided funding for the manuscript. J Smith-Palmer and W Valentine are current employees of Ossian Health Economics and Communications, which has received consulting fees from Eli Lilly and Company. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Type 2 diabetes is a global health problem, although the burden of disease is disproportionately high in some regions (e.g., Western Pacific).

• There are phenotypic differences in Type 2 diabetes between different settings, with East Asian patients having a higher incidence of stroke but lower incidence of coronary heart disease relative to Western populations.

• Proteinuria is more common in East Asian populations and appears to be a stronger cardiovascular risk factor in East Asian populations than in European and North American patients.

• Hypertension is more common and represents a stronger cardiovascular risk factor in African Americans than in other ethnic groups.

• Obesity is defined at lower BMI thresholds in Asian populations, but cardiovascular risk associated with obesity shows no obvious differences from that in Western populations.

• Cardiovascular risk increases as the number of components of metabolic syndrome present increase.

• Patients with Type 2 diabetes from Latin America, Africa and the Middle East are underrepresented in terms of large-scale long-term studies of cardiovascular outcomes.

Notes