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Sharma A, Zheng Y, Ezekowitz JA, et al. Cluster Analysis of Cardiovascular Phenotypes in Patients With Type 2 Diabetes and Established Atherosclerotic Cardiovascular Disease: A Potential Approach to Precision Medicine. Diabetes Care. 2021;doi: 10.2337/dc20-2806.
Sharma, A., Zheng, Y., Ezekowitz, J. A., Westerhout, C. M., Udell, J. A., Goodman, S. G., Armstrong, P. W., Buse, J. B., Green, J. B., Josse, R. G., Kaufman, K. D., McGuire, D. K., Ambrosio, G., Chuang, L. M., Lopes, R. D., Peterson, E. D., & Holman, R. R. (2021). Cluster Analysis of Cardiovascular Phenotypes in Patients With Type 2 Diabetes and Established Atherosclerotic Cardiovascular Disease: A Potential Approach to Precision Medicine. Diabetes care, . https://doi.org/10.2337/dc20-2806
Sharma, Abhinav, et al. "Cluster Analysis of Cardiovascular Phenotypes in Patients With Type 2 Diabetes and Established Atherosclerotic Cardiovascular Disease: A Potential Approach to Precision Medicine." Diabetes care vol. (2021). doi: https://doi.org/10.2337/dc20-2806
Sharma A, Zheng Y, Ezekowitz JA, Westerhout CM, Udell JA, Goodman SG, Armstrong PW, Buse JB, Green JB, Josse RG, Kaufman KD, McGuire DK, Ambrosio G, Chuang LM, Lopes RD, Peterson ED, Holman RR. Cluster Analysis of Cardiovascular Phenotypes in Patients With Type 2 Diabetes and Established Atherosclerotic Cardiovascular Disease: A Potential Approach to Precision Medicine. Diabetes Care. 2021 Oct 29; doi: 10.2337/dc20-2806. Epub 2021 Oct 29. PMID: 34716214.
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Diabetes Care. 2021 Oct 29; doi: 10.2337/dc20-2806. Epub 2021 Oct 29.

Cluster Analysis of Cardiovascular Phenotypes in Patients With Type 2 Diabetes and Established Atherosclerotic Cardiovascular Disease: A Potential Approach to Precision Medicine.

Diabetes care

Abhinav Sharma, Yinggan Zheng, Justin A Ezekowitz, Cynthia M Westerhout, Jacob A Udell, Shaun G Goodman, Paul W Armstrong, John B Buse, Jennifer B Green, Robert G Josse, Keith D Kaufman, Darren K McGuire, Giuseppe Ambrosio, Lee-Ming Chuang, Renato D Lopes, Eric D Peterson, Rury R Holman

Affiliations

  1. Division of Cardiology, McGill University, Montreal, Quebec, Canada [email protected].
  2. Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
  3. Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
  4. Peter Munk Cardiac Centre, University Health Network and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
  5. St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
  6. School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
  7. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
  8. Merck & Co., Inc., Kenilworth, NJ.
  9. Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX.
  10. School of Medicine, University of Perugia, Perugia, Italy.
  11. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
  12. Radcliffe Department of Medicine, University of Oxford, Oxford, U.K.

PMID: 34716214 DOI: 10.2337/dc20-2806

Abstract

OBJECTIVE: Phenotypic heterogeneity among patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) is ill defined. We used cluster analysis machine-learning algorithms to identify phenotypes among trial participants with T2DM and ASCVD.

RESEARCH DESIGN AND METHODS: We used data from the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) study (

RESULTS: Four distinct phenotypes were identified: cluster I included Caucasian men with a high prevalence of coronary artery disease; cluster II included Asian patients with a low BMI; cluster III included women with noncoronary ASCVD disease; and cluster IV included patients with heart failure and kidney dysfunction. The primary outcome occurred, respectively, in 11.6%, 8.6%, 10.3%, and 16.8% of patients in clusters I to IV. The crude difference in cardiovascular risk for the highest versus lowest risk cluster (cluster IV vs. II) was statistically significant (hazard ratio 2.74 [95% CI 2.29-3.29]). Similar phenotypes and outcomes were identified in EXSCEL.

CONCLUSIONS: In patients with T2DM and ASCVD, cluster analysis identified four clinically distinct groups. Further cardiovascular phenotyping is warranted to inform patient care and optimize clinical trial designs.

© 2021 by the American Diabetes Association.

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