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Prevalence of Cardiovascular Disease In Type 2 Diabetes: A Global Systematic Review

      Objectives

      To summarize prevalence rates globally for cardiovascular disease (CVD) in persons with type 2 diabetes (T2DM) published within the last 10 years (2007-2017).

      Methods

      We searched Medline, Embase, and proceedings of scientific meetings to identify published studies documenting the prevalence of CVD among people with T2DM. Search terms included stroke, myocardial infarction, angina, heart failure, ischemic heart disease, cardiovascular disease, coronary heart/artery disease (CAD), atherosclerosis, and cardiovascular death. No restrictions were placed on country of origin or publication language. Two reviewers independently searched for articles and abstracted data, with results adjudicated through consensus. Data were summarized descriptively. Risk of bias was explored by applying the checklist from the STROBE Initiative.

      Results

      We analyzed data from 57 articles with 4,549,481 persons having T2DM. Overall, 51.8% were male, 47.0% obese, 63.6±6.9 years old, with T2DM duration of 10.4±3.7 years. CVD affected 32.2% overall (53 studies, N=4,289,140); 29.1% had atherosclerosis in four studies (N=1,153), 21.2% had CAD (42 articles, N=3,833,200), 14.9% heart failure (14 studies, N=601,154), 14.6% angina (4 studies, N=354,743), 10.0% myocardial infarction (13 studies, N=3,518,833), and 7.6% stroke (40 studies, N=3,901,505). Males had higher rates than females for stroke (6.7% vs. 5.9%), myocardial infarction (11.9% vs. 9.8%), angina (21.1% vs. 17.4%), and CAD (18.7% vs. 14.3%). CVD was cause of death in 9.9% of all T2DM patients (representing 50.3% of all deaths), with CAD responsible for 6.3% (29.7% of all deaths) and cerebrovascular disease for 1.5% (11.0% of all deaths). Risk of death in T2DM doubled with CVD (OR=2.09; CI95%:1.56-2.80) and nearly tripled with concomitant CAD (OR=2.97; CI95%:2.18-4.06). Europe produced the most articles (49%), followed by the Western Pacific/China (19%), and North America (14%). Risk of bias was low, as 80%±12% of the Strobe checklist items were adequately addressed.

      Conclusions

      Globally, CVD affects approximately 32.2% of all persons with T2DM.