A report published on 12 February 2025 in the Journal of the Society for Cardiovascular Angiography and Interventions by Dr Andrew Goldsweig and colleagues investigated the risk of cardiovascular disease in patients with type I diabetes (T1DM) compared to patients with type 2 diabetes (T2DM). While both conditions increase the risk of cardiovascular events, the respective diseases work very differently. T1DM is an autoimmune disorder in which the immune system attacks the pancreas, destroying insulin-producing cells. In contrast, T2DM can occur at any age, including older adulthood, and is considered insulin resistance rather than deficiency. Goldsweig and colleagues measured the number of cardiovascular events that occurred in patients with T1DM or T2DM from 2017-22. This research determined the cardiovascular risk of T1DM patients, and directly compared T1DM and T2DM to determine long-term health outcomes.
The study included 162,027 diabetes patients who were enrolled in the National Cardiovascular Data Registry Veradigm Metabolic Registry (VRM) from 2017-22. These patients were ages 46-75 years, had no previous history of cardiac events, and were receiving outpatient care. Out of these participants, 5,823 patients (3.59%) had T1DM and 156,204 patients (95.41%) had T2DM. The T2DM cohort was slightly older (56-75 years) and had a higher body mass index (BMI) (33.8kg/m²) than the T1DM cohort (46-65 years, 28.4kg/m²).
The study population characteristics revealed that T1DM patients had significantly lower rates of coronary artery disease (7.6% versus 11.8%), heart failure (1.0% versus 4.5%), dyslipidemia (66.7% versus 72.3%), hypertension (51.2% versus 78.9%), and peripheral artery disease (1.0% versus 2.3%) than T2DM patients. This may be due to the mechanism of the disease or the difference in age and BMI between the cohorts.
A total of 11,096 cardiovascular events occurred during the study, including myocardial infarction (MI), stroke, coronary artery bypass grafting (CABG), limb ischemia, percutaneous coronary intervention (PCI), and peripheral revascularisation. The T1DM cohort was at lower risk for MI (56% risk, where equal risk is 100%), PCI (43% risk), stroke (64% risk), and limb ischemia (57% risk) than the T2DM cohort. In turn, the risk of any cardiovascular event was lower in T1DM patients than in T2DM patients (63% risk). The risk of CABG and peripheral revascularisation were comparable between the groups. This trend persisted through all age groups (46-55 years, 56-65 years, and 66-75 years). The cause of this pattern has not yet been established and will likely be the subject of future research. Leading data and analytics company GlobalData epidemiologists forecast that there will be 1.8 million diagnosed prevalent cases of T1DM and 23.6 million diagnosed prevalent cases of T2DM in the US in 2025. T2DM patients are more likely to be obese (over 50% of patients) than T1DM patients (18% of patients) and have higher rates of cardiovascular disease (over 30% of patients versus 12% of patients). While T1DM is not preventable, T2DM can be prevented by maintaining a healthy body weight, getting regular exercise, and choosing a healthy diet.
