title: Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1·9 million people.
abstract: BACKGROUND
  The contemporary associations of type 2 diabetes with a wide range of incident cardiovascular diseases have not been compared. We aimed to study associations between type 2 diabetes and 12 initial manifestations of cardiovascular disease.
  
  
  METHODS
  We used linked primary care, hospital admission, disease registry, and death certificate records from the CALIBER programme, which links data for people in England recorded in four electronic health data sources. We included people who were (or turned) 30 years or older between Jan 1, 1998, to March 25, 2010, who were free from cardiovascular disease at baseline. The primary endpoint was the first record of one of 12 cardiovascular presentations in any of the data sources. We compared cumulative incidence curves for the initial presentation of cardiovascular disease and used Cox models to estimate cause-specific hazard ratios (HRs). This study is registered at ClinicalTrials.gov (NCT01804439).
  
  
  RESULTS
  Our cohort consisted of 1 921 260 individuals, of whom 1 887 062 (98·2%) did not have diabetes and 34 198 (1·8%) had type 2 diabetes. We observed 113 638 first presentations of cardiovascular disease during a median follow-up of 5·5 years (IQR 2·1-10·1). Of people with type 2 diabetes, 6137 (17·9%) had a first cardiovascular presentation, the most common of which were peripheral arterial disease (reported in 992 [16·2%] of 6137 patients) and heart failure (866 [14·1%] of 6137 patients). Type 2 diabetes was positively associated with peripheral arterial disease (adjusted HR 2·98 [95% CI 2·76-3·22]), ischaemic stroke (1·72 [1·52-1·95]), stable angina (1·62 [1·49-1·77]), heart failure (1·56 [1·45-1·69]), and non-fatal myocardial infarction (1·54 [1·42-1·67]), but was inversely associated with abdominal aortic aneurysm (0·46 [0·35-0·59]) and subarachnoid haemorrhage (0·48 [0·26-0.89]), and not associated with arrhythmia or sudden cardiac death (0·95 [0·76-1·19]).
  
  
  CONCLUSIONS
  Heart failure and peripheral arterial disease are the most common initial manifestations of cardiovascular disease in type 2 diabetes. The differences between relative risks of different cardiovascular diseases in patients with type 2 diabetes have implications for clinical risk assessment and trial design.
  
  
  BACKGROUND
  Wellcome Trust, National Institute for Health Research, and Medical Research Council.
authors.affiliation: Farr Institute of Health Informatics Research at London, London, UK; Department of Epidemiology and Public Health, University College London, London, UK. Electronic address: anoop@doctors.org.uk.
authors.forename: Anoop Dinesh
authors.initials: AD
authors.lastname: Shah
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK; MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
authors.forename: Claudia
authors.initials: C
authors.lastname: Langenberg
authors.affiliation: Farr Institute of Health Informatics Research at London, London, UK; Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Eleni
authors.initials: E
authors.lastname: Rapsomaniki
authors.affiliation: Farr Institute of Health Informatics Research at London, London, UK; Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Spiros
authors.initials: S
authors.lastname: Denaxas
authors.affiliation: Farr Institute of Health Informatics Research at London, London, UK; Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Mar
authors.initials: M
authors.lastname: Pujades-Rodriguez
authors.affiliation: Faculty of Medicine and Health, University of Leeds, Leeds, UK.
authors.forename: Chris P
authors.initials: CP
authors.lastname: Gale
authors.affiliation: Farr Institute of Health Informatics Research at London, London, UK; National Institute of Cardiovascular Outcomes Research, University College London, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Deanfield
authors.affiliation: Farr Institute of Health Informatics Research at London, London, UK; Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Liam
authors.initials: L
authors.lastname: Smeeth
authors.affiliation: Farr Institute of Health Informatics Research at London, London, UK; Barts and the London National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary, University of London, London, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Timmis
authors.affiliation: Farr Institute of Health Informatics Research at London, London, UK; Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Harry
authors.initials: H
authors.lastname: Hemingway
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology*; D015331:Cohort Studies; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged