It is well-established that atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality in patients with type 2 diabetes. But the effect of diabetes on incident cardiovascular disease in association with the extent of atherosclerotic disease still remains unknown. A recent study published in ‘scientific reports’ explored the major adverse cardiovascular events (MACE) in patients with or without type 2 diabetes presenting with two extremes of atherosclerotic disease, those with angiographically documented minor coronary atherosclerotic lesions and those with symptomatic peripheral artery disease.

      The observational study included 1238 patients from two prospective, long-term cohort studies. The participants who underwent coronary angiography and/or sonography in order to assess the grade of atherosclerosis were included in the investigation. The follow-up period is reported as the median with interquartile range (IQR), where Q1 represents the 25th percentile, Q2 the median (50th percentile), and Q3 the 75th percentile. During the follow-up period, cardiovascular events and all-cause death were recorded. Standardized interviews were performed at 2-year intervals to assess non-fatal events. Laboratory analyses included C reactive protein, plasma glucose triglycerides, total cholesterol, low density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and HbA1c. Inter-group differences of baseline data were tested for statistical significance with χ2 and Mann-Whitney U tests for categorical and continuous variables as appropriate. Pairwise comparisons of event-free survival between patient groups were done with the Wilcoxon-Gehan statistic. HRs for the incidence of first cardiovascular events were derived from Cox regression analysis.

      The results revealed that MACE occurred more often in patients with type 2 diabetes compared to patients without type 2 diabetes. Further, MACE occurred more frequently in major atherosclerosis group (58.1%), than minor atherosclerosis group (34.1%) or group with no signs of atherosclerosis (19.1%).

      The cox-regression-model analysis highlighted type 2 diabetes as a significant predictor of MACE in univariate analyses (HR = 2.43 [1.88–3.14], p < 0.001) and after multivariate adjustment for cardiovascular risk factors, as well as the different grades of atherosclerosis.

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