Diabetes and the risk of cardiovascular events and all-cause mortality among older adults: an individual participant data analysis of five prospective studies

Valerie Aponte Ribero; Orestis Efthimiou; Nazanin Abolhassani; Heba Alwan; Douglas C Bauer; Séverine Henrard; Antoine Christiaens; Denis O'Mahony; Wilma Knol; Mike J L Peters; Arnaud Chiolero; Drahomir Aujesky; Gérard Waeber; Nicolas Rodondi; Cinzia Del Giovane; Baris Gencer

doi:10.1111/eci.14340

Diabetes and the risk of cardiovascular events and all-cause mortality among older adults: an individual participant data analysis of five prospective studies

Eur J Clin Invest. 2024 Oct 28:e14340. doi: 10.1111/eci.14340. Online ahead of print.

Authors

Valerie Aponte Ribero^{1

2}, Orestis Efthimiou^{1

3}, Nazanin Abolhassani^{1

4}, Heba Alwan^{1

2}, Douglas C Bauer⁵, Séverine Henrard^{6

7}, Antoine Christiaens^{6

8}, Denis O'Mahony⁹, Wilma Knol¹⁰, Mike J L Peters¹⁰, Arnaud Chiolero^{1

11

12}, Drahomir Aujesky¹³, Gérard Waeber¹⁴, Nicolas Rodondi^{1

13}, Cinzia Del Giovane^{1

15}, Baris Gencer^{1

16

17}

Affiliations

¹ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
² Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
³ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
⁴ Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
⁵ Department of Medicine and Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA.
⁶ Clinical Pharmacy research group, Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium.
⁷ Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium.
⁸ Fonds de la Recherche Scientifique - FNRS, Brussels, Belgium.
⁹ School of Medicine, University College Cork, Cork, Ireland.
¹⁰ Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
¹¹ Population Health Laboratory (#PopHealthLab), Department of Community Health, University of Fribourg, Fribourg, Switzerland.
¹² School of Population and Global Health, McGill University, Montreal, Canada.
¹³ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹⁴ Department of Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland.
¹⁵ Department of Medical and Surgical Sciences for Children and Adults, University-Hospital of Modena and Reggio Emilia, Modena, Italy.
¹⁶ Cardiology Division, Geneva University Hospitals, Geneva, Switzerland.
¹⁷ Service of Cardiology, Lausanne University Hospitals, Lausanne, Switzerland.

PMID: 39465996
DOI: 10.1111/eci.14340

Abstract

Background: Guidelines and studies provide conflicting information on whether type 2 diabetes (T2D) should be considered a coronary heart disease risk (CHD) equivalent in older adults.

Methods: We synthesized participant-level data on 82,723 individuals aged ≥65 years from five prospective studies in two-stage meta-analyses. We estimated multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of T2D (presence versus absence) on a primary composite outcome defined as cardiovascular events or all-cause mortality. Secondary outcomes were the components of the composite. We evaluated CHD risk equivalence by comparing outcomes between individuals with T2D but no CHD versus CHD but no T2D.

Results: The median age of participants was 71 years, 20% had T2D and 17% had CHD at baseline. A total of 29,474 participants (36%) experienced the composite outcome. Baseline T2D was associated with higher risk of cardiovascular events or all-cause mortality versus no T2D (HR 1.44, 95% CI [1.40-1.49]). The association was weaker in individuals aged ≥75 years versus 65-74 years (HR 1.32 [1.19-1.46] vs. 1.56 [1.50-1.62]; p-value for interaction = .032). Compared to individuals with CHD but no T2D, individuals with T2D but no CHD had a similar risk of the composite outcome (HR 0.95 [0.85-1.07]), but a lower risk of cardiovascular events (HR 0.76 [0.59-0.98]).

Conclusions: T2D was associated with increased risk of cardiovascular events and all-cause mortality in older adults, but T2D without CHD conferred lower risk of cardiovascular events compared to CHD without T2D. Our results suggest that T2D should not be considered a CHD risk equivalent in older adults.

Keywords: all‐cause mortality; cardiovascular disease; coronary heart disease; diabetes.

Abstract

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