Cardiovascular Outcomes Among Adults with Type 2 Diabetes or Obesity Receiving Carbohydrate-Reduced Nutrition via Telemedicine: A Retrospective Claims-Based Cohort Study.
Cardiovascular (CV) risk factors improve with carbohydrate-reduced nutrition, but the impact on CV outcomes is unknown. We assessed the incidence of CV outcomes associated with a carbohydrate-reduced telemedicine intervention in a retrospective claims-based cohort study.
Adults with type 2 diabetes or obesity receiving individualized nutritional therapy (INT) between January 1, 2016 and June 1, 2025, were compared with propensity score-matched controls. Primary outcomes included (1) 3-point major adverse CV events (MACE), defined as nonfatal myocardial infarction, nonfatal stroke, or death from any cause (MACE-3); (2) 6-point MACE, adding percutaneous coronary intervention, hospitalization for heart failure or unstable angina (MACE-6); (3) all new-onset CV disease (CVD) events; and (4) new-onset hypertension.
In 4877 participants in each cohort (mean age, 51 [SD 9.5] years; 2939 [60.3%] female), INT was associated with lower risk of all primary outcomes. Incidence per 1000 person-years was 4.1 vs. 9.3 for MACE-3, 5.7 vs. 10.8 for MACE-6, 27.7 vs. 36.9 for all new-onset CVD, and 41.8 vs. 49.3 for new-onset hypertension. Hazard ratios were 0.44 (95% CI, 0.29-0.65; P < 0.001) for MACE-3, 0.52 (95% CI, 0.37-0.73; P < 0.001) for MACE-6, 0.70 (95% CI, 0.59-0.82; P < 0.001) for all CVD, and 0.81 (95% CI, 0.70-0.93; P < 0.001) for new-onset hypertension.
Individualized telemedicine nutrition therapy was associated with lower CV event incidence compared to controls, suggesting the intervention may confer cardioprotection.
Adults with type 2 diabetes or obesity receiving individualized nutritional therapy (INT) between January 1, 2016 and June 1, 2025, were compared with propensity score-matched controls. Primary outcomes included (1) 3-point major adverse CV events (MACE), defined as nonfatal myocardial infarction, nonfatal stroke, or death from any cause (MACE-3); (2) 6-point MACE, adding percutaneous coronary intervention, hospitalization for heart failure or unstable angina (MACE-6); (3) all new-onset CV disease (CVD) events; and (4) new-onset hypertension.
In 4877 participants in each cohort (mean age, 51 [SD 9.5] years; 2939 [60.3%] female), INT was associated with lower risk of all primary outcomes. Incidence per 1000 person-years was 4.1 vs. 9.3 for MACE-3, 5.7 vs. 10.8 for MACE-6, 27.7 vs. 36.9 for all new-onset CVD, and 41.8 vs. 49.3 for new-onset hypertension. Hazard ratios were 0.44 (95% CI, 0.29-0.65; P < 0.001) for MACE-3, 0.52 (95% CI, 0.37-0.73; P < 0.001) for MACE-6, 0.70 (95% CI, 0.59-0.82; P < 0.001) for all CVD, and 0.81 (95% CI, 0.70-0.93; P < 0.001) for new-onset hypertension.
Individualized telemedicine nutrition therapy was associated with lower CV event incidence compared to controls, suggesting the intervention may confer cardioprotection.
Authors
Roberts Roberts, Shanmugam Shanmugam, Athinarayanan Athinarayanan, Wolfberg Wolfberg, Raskin Raskin, Lopez-Jimenez Lopez-Jimenez
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