Psychosocial and behavioral risk patterns and risk of cardiovascular complications in people with type 2 diabetes

Introduction: Psychosocial and behavioral risk factors often co-occur in patients with type 2 diabetes (T2D). The clustering of these risk factors and their role in predisposing patients to cardiovascular complications is not well understood. This study aims to identify patient subgroups with distinct psychological and behavioral risk patterns and evaluate the long-term risk of cardiovascular complications associated with these risk patterns. Methods: A total of 24,467 patients with T2D were identified from the UK Biobank (mean age 59 years, 86.7 % white), used Latent Class Analysis (LCA) to distinguish risk patterns among observed psychosocial (social isolation, loneliness, high neuroticism, anxiety, and depression) and behavioral (smoking, alcohol consumption, sleep duration, diet quality, and physical inactivity) risk factors. the Cox proportional hazards model was applied to assess the association of the identified risk patterns and risk of coronary heart disease (CHD), stroke, and a composite CVD (CHD or stroke) accounting for age, age at T2D diagnosis, race, gender, Townsend Deprivation Index, anti-diabetes medications, lipid-lowering medications, and anti-hypertensive medications. Results: Three distinct latent classes were identified: a low-risk group (n = 8,227, 33.62 %), a high psychosocial risk group (n = 15,965, 65.25 %), and a high behavioral risk group (n = 275, 1.12 %). Over a median follow-up of 12 years, the fully adjusted model showed that the high psychosocial risk group had a significantly increased risk of CHD (HR = 1.16; 95 % CI 1.08, 1.24) and composite CVD (HR = 1.13; 95 % CI 1.06, 1.20). Conclusion: The psychosocial risk pattern is significantly associated with the risk of CHD and CVD among patients with T2D. These findings emphasize the importance of integrating psychosocial support into tailored care strategies to mitigate cardiovascular risks in T2D patients.