Khunti K, Hertz CL, Husemoen LLN, et al. - A 5–7 years’ follow-up in people with type 2 diabetes revealed that the rate of major adverse cardiovascular events was 14.0 and 49.6 events/1000 person-years in those without and with established cardiovascular disease, respectively (hazard ratio [HR] 0.28). This study offers essential information to find persons who may benefit from primary prevention of cardiovascular disease.

• Using the UK Clinical Practice Research Datalink GOLD database, data were obtained from 53,182 type 2 diabetes patients initiating second-line glucose-lowering medication.

• Overall 19.4% of participants had established cardiovascular disease (i.e. a prior cardiovascular event).

• Estimated glomerular filtration rate < 60 mL/min was linked with the highest risk of major adverse cardiovascular events (HR 0.75) and mortality (HR 1.12) in those without established cardiovascular disease, vs a reference HR 1.0 for those with established cardiovascular disease.

• A similarly high risk of cardiovascular events in those without vs those with established cardiovascular disease was found in relation to the combination of chronic kidney disease with older age, smoking and/or dyslipidemia.

• Early control of modifiable cardiovascular risk factors in all people with type 2 diabetes (as well as in all persons with cardiovascular disease) is recommended.