Sarabhai Theresia, Kostev Karel
Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
Epidemiology, IQVIA, Frankfurt am Main, Germany.
J Diabetes. 2025 Jun;17(6):e70099. doi: 10.1111/1753-0407.70099.
Events of cardiovascular disease (CVD) remain a critical concern in patients with Type 2 diabetes mellitus (T2D). Over 17 years, this study analyzed time changes in the 5-year incidence of myocardial infarction (MI), chronic coronary heart disease (CHD), transient ischemic attack (TIA), and ischemic stroke (IS).
This retrospective cohort study was conducted using the Disease Analyzer database, including patients aged ≥ 18 years with at least 12 months of no prior CVD with new-onset T2D in 2001-2006 (n = 10 162) and in 2013-2018 (n = 30 486), matched 1:3 by age and sex. Kaplan-Meier survival analysis estimated the 5-year cumulative incidence of the outcomes. Multivariable Cox regression models assessed temporal changes, adjusted for comorbidities.
The incidence of CHD and TIA significantly declined in 2013-2018 compared to 2001-2006, with HRs of 0.68 (95% CI: 0.63-0.73; p < 0.001) and 0.63 (95% CI: 0.52-0.76; p < 0.001), respectively. Reductions were more pronounced in women and older patients. Surprisingly, MI incidence showed only a trend of reduction (HR: 0.82; 95% CI: 0.68-0.99; p = 0.045) and IS incidence was not different (HR: 0.97; 95% CI: 0.85-1.12; p = 0.722) between time periods.
This study is the first to report time trends in CVD incidence in new-onset T2D in Germany. From 2001 to 2018, the 5-year incidence of CHD and TIA decreased in new-onset T2D, reflecting demographic-specific advancements in diabetes and cardiovascular care. However, the stable incidence of IS and MI underscores a persistent challenge in prevention strategies in patients with prediabetes and T2D.
心血管疾病（CVD）事件仍是2型糖尿病（T2D）患者的关键关注点。在17年的时间里，本研究分析了心肌梗死（MI）、慢性冠心病（CHD）、短暂性脑缺血发作（TIA）和缺血性卒中（IS）5年发病率的时间变化。
本回顾性队列研究使用疾病分析器数据库进行，纳入了年龄≥18岁、在2001 - 2006年（n = 10162）和2013 - 2018年（n = 30486）新诊断为T2D且至少12个月无既往CVD病史的患者，并按年龄和性别1:3进行匹配。Kaplan - Meier生存分析估计了结局的5年累积发病率。多变量Cox回归模型评估了时间变化，并对合并症进行了校正。
与2001 - 2006年相比，2013 - 2018年CHD和TIA的发病率显著下降，风险比（HR）分别为0.68（95%置信区间：0.63 - 0.73；p < 0.001）和0.63（95%置信区间：0.52 - 0.76；p < 0.001）。女性和老年患者的下降更为明显。令人惊讶的是，MI发病率仅呈下降趋势（HR：0.82；95%置信区间：0.68 - 0.99；p = 0.045），且两个时间段之间IS发病率无差异（HR：0.97；95%置信区间：0.85 - 1.12；p = 0.722）。
本研究首次报告了德国新诊断T2D患者CVD发病率的时间趋势。从2001年到2018年，新诊断T2D患者中CHD和TIA的5年发病率下降，反映了糖尿病和心血管护理在特定人群中的进展。然而，IS和MI发病率的稳定凸显了糖尿病前期和T2D患者预防策略中持续存在的挑战。
