Key result
A higher 30% CVD risk threshold is linked to ~2% more CVD events in older T2DM.
Why the study?
Does intensifying primary care encounter frequency at a CVD risk threshold of >30% compared to >20% increase the 5-year incidence of CVD in patients with T2DM?
Cohort (n=44,813)
Yes
Does intensifying primary care encounter frequency at a CVD risk threshold of >30% compared to >20% increase the 5-year incidence of CVD in patients with T2DM?
Answers are grounded in this paper and cite their sources.
Intensifying primary care follow-up for T2DM patients at a 30% vs 20% CVD risk threshold is safe for patients under 60 but significantly increases 5-year CVD risk in those 60 and older.
BACKGROUND: Determining optimal timing for intensifying the frequency of physician encounters for type 2 diabetes mellitus (T2DM) requires trade-offs between timely care and clinician burden. We aimed to investigate age-specific cardiovascular disease (CVD) risk thresholds used for intensifying encounter frequency in patients with T2DM in primary care. METHODS: Using population-based public electronic health records from the Hospital Authority Clinical Management System in Hong Kong, we used data from patients with a baseline 10-year CVD risk of lower than 20% and a regular follow-up interval of 4-6 months at public primary care clinics. We compared different CVD risk thresholds (> 20% v. 30%) at which to shorten follow-up intervals to 3 months or less. We investigated age-specific effects by categorizing patients into 4 age groups (< 50, 50-59, 60-69, and ≥ 70 yr). In the causal framework of the target trial emulation, we used a dynamic marginal structural model to estimate absolute risk differences for 5-year incidence of CVD, under the assumption of no unmeasured confounding. RESULTS: We identified 44 813 patients. Compared with the risk threshold of 20%, adopting the threshold of 30% did not increase risk of overall CVD in patients younger than 50 years (absolute risk difference 0.2%, 95% confidence interval [CI] -0.6% to 1.0%]) and aged 50-59 years (absolute risk difference 0.7%, 95% CI -0.1% to 1.4%). However, we observed an increased risk in older patients, aged 60-69 years (absolute risk difference 1.5%, 95% CI 0.6% to 2.5%) and 70 years or older (absolute risk difference 2.7%, 95% CI 0.6% to 4.9%). INTERPRETATION: When adopting a less stringent CVD risk threshold of 30% to intensify encounter frequency, we found progressively increasing risks with age for 5-year CVD incidence, and age 60 years appears to be a point where the risk becomes pronounced. Our findings suggest that a less stringent threshold could be considered for patients with T2DM who are younger than 60 years but not for those older than 60 years.
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Xu et al. (2025) conducted a cohort in Type 2 diabetes mellitus (T2DM) (n=44,813). CVD risk threshold of 30% to shorten follow-up intervals to ≤3 months vs. CVD risk threshold of 20% was evaluated on 5-year incidence of CVD (absolute risk difference 1.5% (for age 60-69 years), 95% CI 0.6-2.5). Adopting a CVD risk threshold to intensify care did not increase 5-year CVD risk in T2DM patients <60 years, but increased risk in those aged 60-69 and ≥70 years.
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