Long-term Risk of Cardiovascular Disease in Individuals with Latent Autoimmune Diabetes of Adults (UKPDS 85)

AIMS: Latent Autoimmune Diabetes of Adults (LADA) is diagnosed in up to 12% of adults with clinically-diagnosed type 2 diabetes (T2D). LADA tend to have healthier cardiovascular (CV) risk profiles than T2D, but it remains uncertain whether their risk of CV events differ. We examined the risk of CV events in patients enrolled in the United Kingdom Prospective Diabetes Study (UKPDS), according to their LADA status. MATERIALS AND METHODS: Diabetes autoantibodies (AAb) were measured in 5,062 UKPDS participants. The incidence of major adverse CV events (MACE), defined as CV death, nonfatal myocardial infarction or nonfatal stroke, was compared in those with LADA (≥1 AAb test positive) and those without LADA (AAb negative). RESULTS: There were 567 LADA participants (11.2%). Compared with T2D, they were younger, with higher mean HbA1c and HDL-cholesterol values but lower body mass index, total cholesterol and systolic blood pressure values (all p<0.01). After median (IQR) 17.3 (12.6-20.7) years follow-up, MACE occurred in 157 (17.4 per 1000 person-years) LADA and 1544 (23.5 per 1000 person-years) T2D participants respectively (HR 0.73, 95% Confidence Interval [CI] 0.62-0.86, p<0.001). However, after adjustment for confounders, this difference was no longer significant (HRadj 0.90, 95% CI 0.76-1.07, p=0.22). CONCLUSIONS: In adults thought to have newly-diagnosed T2D the long-term risk of MACE was lower in those with LADA. However, this did not differ after adjustment for conventional CV risk factors suggesting that measurement of AAb in addition to traditional CV risk factors will not aid CV risk stratification in clinically-diagnosed T2D. FUNDING: EFSD Mentorship Programme