This high-quality observational study suggests that there is still clinically significant residual cardiovascular risk in people living with type 2 diabetes, even when cardiovascular risk factors are optimally managed. Over 6 years of follow-up in Scotland, cardiovascular events occurred in 31% of people with type 2 diabetes, while UK-wide data over 3 years of follow-up revealed cardiovascular events in 27% of people with type 2 diabetes versus 19% of matched controls without the condition. Compared to controls, people with type 2 diabetes and optimal cardiovascular risk factor control still had a 21% higher risk of CVD events. Surprisingly, in those with type 2 diabetes but without cardiovascular and/or renal disease, there was a stronger association between the degree of risk factor control and the subsequent risk of cardiovascular events and mortality compared to those with type 2 diabetes and comorbid cardiorenal disease. These findings have significant implications for all working in primary care and suggest that early and more intensive intervention is required in those living with type 2 diabetes who are deemed to be at lower risk; that is, those without established cardiorenal disease.
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