Cardiovascular risk associated with intellectual disability among adults with type 2 diabetes: a nationwide cohort study in South Korea

초록

Background Individuals with intellectual disability (ID) are at elevated risk for cardiovascular disease (CVD), a vulnerability compounded by coexisting type 2 diabetes (T2D). We evaluated the extent to which ID is associated with incident CVD by directly comparing ID with both non-ID disabilities and no disabilities. Methods We conducted a nationwide, population-based cohort study of adults with T2D (aged >= 20 years) in South Korea, with health screenings between January 1, 2015, and December 31, 2016, and follow-up until December 31, 2022 (median 5.9 years). Individuals with a prior myocardial infarction (MI) or ischemic stroke, missing covariates, or a cardiovascular event within the first year of follow-up were excluded. Disability was classified as ID, non-ID disabilities, or no disabilities using the Korea National Disability Registration System. The primary outcome was incident CVD, defined as MI (ICD-10: I21-22) or ischemic stroke (ICD-10: I63-64), assessed throughout follow-up. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards models. Findings Of 2,062,821 adults with T2D, 4574 (0.22%) had ID, 173,350 (8.4%) had non-ID disabilities, and 1,884,897 (91.4%) had no disabilities, and 111,450 incident CVD events were recorded during follow-up. The ID group had the highest CVD risk compared to those with no disabilities (HR 1.72; 95% CI 1.52-1.94), substantially exceeding non-ID disabilities (HR 1.35; 95% CI 1.33-1.37; P < .001). This vulnerability was most pronounced for ischemic stroke (HR 1.91; 95% CI 1.62-2.25), and remained evident even in mild ID (HR 1.61; 95% CI 1.36-1.91). Interpretation ID is associated with a substantially greater CVD risk burden in adults with T2D than other disabilities, particularly for ischemic stroke. Future studies are needed to evaluate long-term cardiovascular trajectory and targeted prevention strategies in this population.

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