Association of cardiometabolic multimorbidity and depression with cardiovascular events in early-onset adult type 2 diabetes: a multi-ethnic study in the USA
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Research Design and Methods: From US electronic medical record, 101,104 AA and 505,336 WC subjects with type 2 diabetes diagnosis between 2000-2017 were identified (mean follow-up: 5.3 years). Among those without ASCVD at diagnosis, risk of ASCVD and MACE-3 (HF, myocardial infarction, or stroke) was evaluated between ethnicities by age groups.
Results: Proportion of patients diagnosed at <50 years increased during 2012-2017 (AA: 34-38%; WC: 26-29%). Depression prevalence increased during 2000-2017 (AA: 15-23%; WC: 20-34%) with an increasing trend for CM at diagnosis in both groups.
Compared to WC, the adjusted MACE-3 risk was significantly higher in AA across all age groups, more pronounced in 18-39 years group (HR CI: 1.42-1.88) and in people with and without depression. AA had 17% (HR CI: 1.05-1.31) significantly higher adjusted ASCVD risk in the 18-39 years group only. Depression was independently associated with ASCVD and MACE-3 risk in both ethnic groups across all age groups. Other comorbidities were independently associated with ASCVD and MACE-3 risk only among WC.
Conclusions: AA have higher cardiovascular risk compared to WC, particularly in early-onset T2DM. CM and depression at diabetes diagnosis has been increasing over last two decades in both ethnic groups. Strategies for screening and optimal management of CM and depression particularly in early-onset T2DM may result in a lower cardiovascular risk.