Risk of a Recurrent Cardiovascular Event in Individuals With Type 2 Diabetes or Intermediate Hyperglycemia: The Hoorn Study

OBJECTIVE

To investigate risk of a recurrent cardiovascular event and its predictors in a population-based cohort.

RESEARCH DESIGN AND METHODS

Participants of the Hoorn Study who had experienced a first cardiovascular event after baseline (n = 336) were followed with respect to a recurrent event. Absolute risk of a recurrent event was calculated for individuals with normal glucose metabolism, intermediate hyperglycemia, and type 2 diabetes. Cox regression models were used to investigate which variables, measured before the first vascular event, predicted a recurrent event using the stepwise backward procedure.

RESULTS

During a median follow-up of 4.1 years, 44% (n = 148) of the population developed a recurrent vascular event. The rate of recurrent events per 100 person-years was 7.2 (95% CI 5.8–8.7) in individuals with normal glucose metabolism, compared with 9.8 (6.6–14.0) in individuals with intermediate hyperglycemia and 12.5 (8.5–17.6) in individuals with type 2 diabetes. Higher age (hazard ratio 1.02 [95% CI 1.00–1.04]), male sex (1.56 [1.08–2.25]), waist circumference (1.02 [1.02–1.03]), higher systolic blood pressure (1.01 [1.01–1.02]), higher HbA_1c (%, 1.13 [0.97–1.31]/ mmol/mol, 1.01 [1.00–1.03]), and family history of myocardial infarction (1.38 [0.96–2.00]) predicted a recurrent cardiovascular event.

CONCLUSIONS

Individuals with type 2 diabetes, but not individuals with intermediate hyperglycemia, are at increased risk for a recurrent vascular event compared with individuals with normal glucose metabolism. In people with a history of cardiovascular disease, people at increased risk of a recurrent event can be identified based on the patient’s risk profile before the first event.Due to aging, the increasing prevalence of obesity and diabetes worldwide, and improved care after a first cardiovascular event, the number of people at risk for a recurrent cardiovascular event is increasing (1).High blood pressure levels, dyslipidemia, smoking, and type 2 diabetes are known risk factors for a first cardiovascular event in the general population, with addition of glycemic level (HbA_1c) in individuals with diabetes (2–4). Also, individuals in a prediabetic state (elevated glucose levels) are at increased risk for a first cardiovascular event compared with individuals with normal glucose metabolism (5).In 1998, the cumulative incidence of recurrent events in patients with and without type 2 diabetes was described (5). Since then, care after a first cardiovascular event has improved, which might have affected absolute risk of a recurrent event. Less is known about predictors of a recurrent cardiovascular event in the general population. In general, established risk factors for a first event have not been found to be predictive for a recurrent event regarding various outcomes (6–8).In the current study, we investigated whether people in a prediabetic state as well as people with type 2 diabetes are at increased risk of a recurrent cardiovascular event compared with people with normal glucose metabolism. To enable identification of individuals at high risk for a recurrent event and consequently effectively target screening, predictors of a recurrent cardiovascular event were determined, based on the patient’s risk profile before the first event.