OBJECTIVES A systematic literature review of longitudinal studies across a broad range of both general and disease specific populations was performed to understand characteristics of patients with type 2 diabetes (T2D) with risk factors for cardiovascular (CV) events and whether the magnitude of CV risk varies across different T2D populations. METHODS MeSH term based literature searches were performed in the PubMed, EMBASE and Cochrane Library databases.  For inclusion, studies (in any disease area) were required to have a minimum of 1,000 T2D patients and minimum 5 years follow up.  After 2 rounds of review a total of 52 articles and 2 meta-analyses were included. RESULTS

Twenty nine articles were described as prospective studies; 13 articles were from Europe, 20 from Asia Pacific, 13 from North America, 2 from the Middle East and 4 were multinational.  Six articles were sourced from general or non-diabetes specific data and 46 articles were based on diabetes studies. Several publications were from large scale diabetes registries (e.g. Hong Kong Diabetes Registry [n=6] and the Swedish National Diabetes Register [n=4]).  The review also identified several post-hoc analyses from clinical trials and large scale retrospective observational/database analyses.

Risk factors investigated included well characterized markers in T2D patients (e.g. HbA1c, blood pressure, lipids, proteinuria [n=20]), less well characterized factors including dietary components (n=7), biochemical measures (e.g. serum uric acid, fibrinogen; n=6), depression (n=6) and poorly characterized risk factors including oral health (n=1), erectile dysfunction (n=1) and presence of H. pylori (n=1). 

CONCLUSIONS

Analysis of the literature showed that in addition to traditional risk markers, factors such as depression, erectile dysfunction, poor oral health are also independent risk factors for CV disease.  These factors should be taken into account when estimating the CV risk profile for patients with T2D.