Risk Stratification for Cardiovascular Disease Based on Prior Coronary Artery Disease, Cerebrovascular Disease and Diabetes Mellitus

Abstract

Abstract Background: Although the impact of a history of coronary artery disease (CAD), cerebrovascular disease (CVD) or both and diabetes mellites (DM) on cardiovascular disease is essential for cardiovascular risk management in clinical practice, little is known about such an impact. Therefore, we investigated the association of prior CAD, prior CVD, DM and their combinations with the risk of subsequent cardiovascular disease. Methods: This historical cohort study included 342,033 participants aged 18-72 years followed for ≥5 years between 2008-2016. Eight groups were created according to whether they were with or without prior CAD, prior CVD and/or DM. DM was defined by fasting plasma glucose, HbA1c and antidiabetic drug prescription. Prior and subsequent CAD and CVD were identified by claims using ICD-10 codes, medical procedures and questionnaires. Cox regression models evaluated the risk of cardiovascular events. Results: Median follow-up period was 6.4 years. Incidence of composite cardiovascular events due to CAD and/or CVD in CAD-/CVD-, CAD+/CVD-, CAD-/CVD+ and CAD+/CVD+ groups were 1.92, 6.94, 25.14 and 31.98 per 1,000 person-years in non-DM and 8.66, 18.04, 39.98 and 60.72 in DM, respectively. Hazard ratio of cardiovascular events compared to CAD-/CVD-/non-DM were 1.66 (95% CI 1.55-1.78) in CAD-/CVD-/DM and 1.84 (1.56-2.18) in CAD+/CVD-/non-DM. CVD+ increased the risk of cardiovascular events approximately 4- to 7- fold regardless of CAD+ or DM. Conclusions:DM increase the risk of cardiovascular disease as high as a history of CAD, while prior CVD alone increased the risk of future cardiovascular disease without additional effects by DM.