Epidemiology of Second Attack of Cardiovascular Events in Patients with Type 2 Diabetes

The incremental risks of cardiovascular disease (CVD) after the first CVD event remain unclear because of the difficulty of assessing how risks changed from the pre-event to the post-event period. A long-term follow-up study was conducted in patients with type 2 diabetes. The endpoints were CVD, defined as ischemic stroke (IS) or coronary artery disease (CAD), and all-cause mortality. Two cohorts were defined: the pre-event and post-event cohorts. The incidence was analyzed using the Kaplan–Meier method, and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. The post-event cohort was further stratified by the type of the first event (IS or CAD). Among 2535 participants, 317 had a first CVD event, and 293 were included in the post-event cohort. Compared with the pre-event cohort, the post-event cohort had significantly higher risks of recurrent CVD (adjusted HR 2.24, 95% CI 1.63–3.06) and all-cause mortality (adjusted HR 2.07, 95% CI 1.59–2.69). Within the post-event cohort, recurrent CVD risk showed no difference between the IS and CAD groups, but all-cause mortality was significantly higher in the IS group. Patients with type 2 diabetes who experienced a first CVD event had a twofold increased risk of recurrent CVD events and all-cause mortality.