Nationwide Trends in Cardiac Risk and Mortality in Patients With Incident Type 2 Diabetes: A Danish Cohort Study

OBJECTIVE Trends in cardiac risk and death have not been examined in patients with incident type 2 diabetes and no prior cardiovascular disease. Therefore, we aimed to examine trends in cardiac risk and death in relation to use of prophylactic cardiovascular medications in patients with incident type 2 diabetes without prior cardiovascular disease. RESEARCH DESIGN AND METHODS In this population-based cohort study, we included patients with incident type 2 diabetes between 1996 and 2011 through national health registries. Each patient was matched by age and sex with up to 5 persons without diabetes from the general population. All individuals were followed for 7 years. RESULTS We identified 209,311 patients with incident diabetes. From 1996-1999 to 2008-2011, the 7-year risk of myocardial infarction decreased from 6.9% to 2.8% (adjusted hazard ratio [aHR] 0.39, 95% CI 0.37-0.42), cardiac death from 7.1% to 1.6% (aHR 0.23, 95% CI 0.21-0.24), and all-cause death from 28.9% to 16.8% (aHR 0.68, 95% CI 0.66-0.69). Compared to the general population, 7-year risk differences decreased from 3.3% to 0.8% for myocardial infarction, from 2.7% to 0.5% for cardiac death, and from 10.6% to 6.0% for all-cause death. Use of cardiovascular medications within ±1 year of diabetes diagnosis, especially statins (5% users in 1996-1999 vs. 60% in 2008-2011), increased during the study period. CONCLUSIONS From 1996 to 2011, Danish patients with incident type 2 diabetes and no prior cardiovascular disease experienced major reductions in cardiac risk and mortality. The risk reductions coincided with increased use of prophylactic cardiovascular medications.