Ethnicity and prognosis following a cardiovascular event in people with and without type 2 diabetes: observational analysis in over 5 million subjects in England

Aims: To quantify ethnic differences in the risk of all–cause mortality and cardiovascular disease (CVD) events following a first CVD event in people with and without type 2 diabetes.

Methods: We identified 5,349,271 subjects with a first CVD between 1 January 2002 and 31 May 2020 in England; CVD included aortic aneurism, cerebrovascular accident, heart failure, myocardial infarction, peripheral vascular disease, and other cardiovascular diseases. We estimated adjusted hazard ratios (HRs) for type 2 diabetes and ethnicity of three outcomes: fatal and nonfatal second CVD event (different phenotype compared to the first) and all–cause mortality.

Results: Relative to White, HRs indicated lower rates in all ethnicities and for all outcomes in both men (from 0.64 to 0.79 for all–cause death; 0.78–0.79 for CVD–related death; and 0.85–0.98 for a second CVD event) and women (0.69–0.77; 0.77–0.83; 0.83–0.95, respectively). Irrespective of ethnicity and sex, type 2 diabetes increased rates of all outcomes by around a third.

Conclusions: Prognosis following a CVD event was consistently worse in subjects with type 2 diabetes while varied across ethnicities, suggesting the implementation of different strategies for the secondary prevention of CVD in different ethnic groups.