Distribution of cardiovascular risk in type 2 diabetes: results of an analysis using data from CAPTURE study

Presented at the EASD 2021 by: Jan Westerink, MD, PhD – Utrecht, The Netherlands

Introduction and methods

It is well known that patients with diabetes have an increased CV risk, but absolute risk differs between patients. Novel glucose-lowering agents with proven CV benefit, SGLT2is and GLP-1RAs, can be used in diabetes patients to lower CV risk. The use of these agents is supported in the most recent EASD and ESC guidelines.

In this study, distribution of 10-year and lifetime CVD risk were estimated using the DIAL model in patients in the CAPTURE study. In addition, treatment patterns, including use of SGLT2i and GLP-1RAs, were assessed based on risk.

The CAPTURE study was a non-interventional, cross-sectional study in which characteristics of almost 10,000 patients with T2DM were collected in 13 countries across 5 continents in 2019. The DIAL model is an externally validated competing risk-adjusted model for lifetime predictions of MACE and non-CV-related mortality in patients with T2DM.

In this study, high CV risk was defined as 10-year CV risk >10% or lifetime risk >50%.

Main results

• There was a wide distribution of 10-year CVD risk in patients with a history of CVD (mean risk was 40%) and in patients without a history of CVD (mean risk was 5%).
• 96% Of patients with a history of CVD had a 10-year risk >10%. In patients without a history of CVD, only 14% had a 10-year risk >10%.
• Similar, there was a wide distribution of lifetime CVD risk in patients with a history of CVD (mean risk was 65%) and in patients without a history of CVD (mean risk was 10%).
• 80% Of patients with a history of CVD had a lifetime risk >50% and in patients without a history of CVD, only 0.4% had a lifetime risk >50%.
• There was no trend for use of SGLT2i and GLP-1RAs by deciles of lifetime CV risk. Use of these agents was similar in patients with and without history of CVD (SGLT2i use was 18% and GLP-1RAs use 10% in patients with CVD and SGLT2i use was 16% and GLP-1RAs use 11% in those without a history of CVD).

Conclusion

This study using data of the CAPTURE study showed that 10-year and lifetime CVD risk are widely distributed. Only a minority of patients receives GLP-1RAs and SGLT2is, with no difference in patients with or without a history of CVD.

Dr. Westerink ended his presentation by saying that shared decision making in the clinical setting can be greatly enhanced by discussions with patients on their 10-year and lifetime CV risk and the estimated benefit that can be gained from preventive interventions.

• Our reporting is based on the information provided at the EASD Virtual Meeting–