Background: Type 2 diabetes mellitus is closely linked with cardiovascular disease, hypertension, and rhythm disorders through shared mechanisms including metabolic dysfunction, vascular inflammation, autonomic imbalance, and structural cardiac remodeling. Understanding how cardiovascular risk factors cluster among patients with arrhythmias before, after, or at the time of type 2 diabetes diagnosis may help identify opportunities for earlier cardiometabolic risk detection and management.

Objective: To describe the burden of cardiovascular risk factors and cardiovascular disease among patients with arrhythmias of interest in relation to the timing of type 2 diabetes diagnosis.

Methods: This retrospective real-world analysis used the Symphony Integrated Dataverse national claims database (2018-2024) to identify adults with type 2 diabetes and arrhythmias of interest. Patients were stratified by the temporal relationship between arrhythmia and diabetes diagnosis: arrhythmia prior to type 2 diabetes, arrhythmia after type 2 diabetes, or arrhythmia and type 2 diabetes recorded on the same day. Cardiovascular risk factors and cardiovascular conditions were assessed within 6 months before or after the arrhythmia index date. Categories included overall cardiovascular risk factors, non-major adverse cardiovascular event cardiovascular disease, hypertension, and major adverse cardiovascular events (MACE), defined to include stroke, myocardial infarction, congestive heart failure, and acute coronary syndrome. Arrhythmias evaluated included atrial fibrillation, atrial flutter, atrioventricular block, supraventricular tachycardia, and ventricular tachycardia.

Results: The analysis included 487,436 patients with arrhythmia before type 2 diabetes, 537,076 with arrhythmia after type 2 diabetes, and 118,862 with same-day arrhythmia and diabetes diagnoses. Cardiovascular risk factors were common, affecting 256,454 patients in the pre-diabetes arrhythmia group, 135,853 in the post-diabetes arrhythmia group, and 62,642 in the same-day group. Hypertension represented the most frequent cardiovascular risk factor across temporal strata. Atrial fibrillation was the dominant arrhythmia phenotype in every subgroup, observed in approximately 79% to 87% of patients with cardiovascular comorbidity. Atrial flutter, supraventricular tachycardia, and ventricular tachycardia were generally more frequent among patients with non-MACE cardiovascular disease or MACE, particularly when arrhythmia preceded type 2 diabetes. Ventricular tachycardia was observed in 17% of patients with MACE in the pre-diabetes arrhythmia group, compared with 7% in the post-diabetes group and 9% in the same-day group.

Conclusions: Cardiovascular comorbidities, especially hypertension and MACE-related conditions, are highly prevalent among patients with arrhythmias and type 2 diabetes. Atrial fibrillation predominates across temporal relationships, underscoring the strong overlap between cardiometabolic disease and atrial arrhythmia burden. These findings support integrated cardiovascular and metabolic risk assessment in patients presenting with either arrhythmia or type 2 diabetes, particularly around the time of diagnosis. Further longitudinal analyses are warranted to clarify directionality, risk progression, and opportunities for earlier intervention.

Ken Boyle, DC, MBA, FIAMA, HEOR-C, is a healthcare executive and health economics leader specializing in health economics and outcomes research (HEOR), real-world evidence, and value-based healthcare. At iRhythm Technologies, he focuses on translating clinical and economic evidence into strategies that demonstrate the value of cardiac diagnostics and earlier arrhythmia detection. With a unique background spanning clinical practice, business, and health economics, He brings a pragmatic, patient-centered perspective to healthcare innovation, evidence generation, and decision-making. His work is grounded in a simple principle: improving healthcare value begins and ends with the patient.