Genetic Predisposition to Type 2 Diabetes and Risk of Subclinical Atherosclerosis and Cardiovascular Diseases Among 160,000 Chinese Adults

In observational studies, type 2 diabetes is associated with two- to fourfold higher risk of cardiovascular diseases (CVD). Using data from the China Kadoorie Biobank (CKB), we examined associations of genetically predicted type 2 diabetes with CVD among ∼160,000 participants to assess whether these relationships are causal. A type 2 diabetes genetic risk score (comprising 48 established risk variants) was associated with the presence of carotid plaque (odds ratio 1.17 [95% CI 1.05, 1.29] per 1 unit higher log-odds of type 2 diabetes; <i>n</i> = 6,819) and elevated risk of ischemic stroke (IS) (1.08 [1.02, 1.14]; <i>n</i> = 17,097), nonlacunar IS (1.09 [1.03, 1.16]; <i>n</i> = 13,924), and major coronary event (1.12 [1.02, 1.23]; <i>n</i> = 5,081). There was no significant association with lacunar IS (1.03 [0.91, 1.16], <i>n</i> = 3,173) or intracerebral hemorrhage (ICH) (1.01 [0.94, 1.10], <i>n</i> = 6,973), although effect estimates were imprecise. These associations were consistent with observational associations of type 2 diabetes with CVD in CKB (<i>P</i> for heterogeneity >0.3) and with the associations of type 2 diabetes with IS, ICH, and coronary heart disease in two-sample Mendelian randomization analyses based on summary statistics from European population genome-wide association studies (<i>P</i> for heterogeneity >0.2). In conclusion, among Chinese adults, genetic predisposition to type 2 diabetes was associated with atherosclerotic CVD, consistent with a causal association.