Prevalence of Cardiovascular Disease by Vascular Bed in Type 2 Diabetes Population in a Real‐World Setting


BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is a major cause of morbidity and mortality in patients with type 2 diabetes (T2D). Real-world claims data were used to assess the prevalence of established ASCVD by vascular bed in patients with T2D.

METHODS: This was a retrospective, cross-sectional analysis of a large US administrative claims database. Inclusion criteria were: >= 2 T2D diagnoses or >= 1 T2D diagnosis + >=1 oral anti-diabetic drug claim, and no more than 1 T1D diagnosis; >=18 years of age; and continuous health plan enrolment in 2014-2015. All diagnoses were identified using ICD-9/-10 codes. Eligible patients were divided by absence or presence of ASCVD. ASCVD diagnoses of interest were those included in the 2017 American Diabetes Association Standard of Care for ASCVD, classified by 3 vascular beds: 1) cerebrovascular disease (stroke, transient ischaemic attack [TIA]), 2) coronary heart disease (acute coronary syndrome [ACS], angina, myocardial infarction), and 3) peripheral arterial disease [PAD]. Sub-group analyses were conducted for 3 age groups (18-44, 45-64, and 65+ years).

RESULTS: The study population included 539,089 patients with T2D who had ASCVD affecting 1 (53.9%), 2 (29.1%) or 3 (17.9%) vascular beds. The three most prevalent ASCVD diagnoses were ACS (26.6%), PAD (24.5%), and stroke (18.6%). Mean age increased with number of affected vascular beds: 1 (63.0 y), 2 (68.6 y), and 3 (73.8 y). Mean total healthcare costs also increased from 1 ($17,741), 2 ($25,877), to 3 ($33,412) affected vascular beds, with between-group differences primarily driven by medical, not pharmacy, costs. Among patients with ASCVD affecting only 1 vascular bed, mean total healthcare costs were similar across the 3 age subgroups; however, if 2 or 3 vascular beds were affected, mean total healthcare cost was negatively age-associated (i.e., higher costs in younger age groups).

CONCLUSIONS: In this analysis of a large, real world claims database, almost half of patients with T2D and ASCVD had ASCVD affecting more than one vascular bed, which was associated with increased mean total healthcare costs.

Read More

ACC 2019 Poster.