<b>Objective:
</b>To evaluate
the temporal patterns of cardiometabolic multimorbidity (CM) and depression in
White Caucasian (WC) and African American (AA) with early-onset type 2
diabetes, and their impact on long-term Atherosclerotic Cardiovascular Disease
(ASCVD).
<p><b>Research
Design and Methods: </b>From US electronic medical record, 101,104 AA and
505,336 WC subjects with type 2 diabetes diagnosis between 2000-2017 were
identified (mean follow-up: 5.3 years). Among those without ASCVD at diagnosis,
risk of ASCVD and MACE-3 (HF, myocardial
infarction, or stroke) was evaluated between ethnicities by age groups. </p>
<p><b>Results:
</b>Proportion of patients
diagnosed at <50 years increased during 2012-2017 (AA: 34-38%; WC: 26-29%). Depression
prevalence increased during 2000-2017 (AA: 15-23%; WC: 20-34%) with an
increasing trend for CM at diagnosis in both groups. </p>
<p>Compared
to WC, the adjusted MACE-3 risk was significantly higher in AA across all age
groups, more pronounced in 18-39 years group (HR CI: 1.42-1.88) and in people
with and without depression. AA had 17% (HR CI: 1.05-1.31) significantly higher
adjusted ASCVD risk in the 18-39 years group only. Depression was independently
associated with ASCVD and MACE-3 risk in both ethnic groups across all age
groups. Other comorbidities were independently associated with ASCVD and MACE-3
risk only among WC. </p>
<p><b>Conclusions:
</b>AA have
higher cardiovascular risk compared to WC, particularly in early-onset T2DM. CM
and depression at diabetes diagnosis has been increasing over last two decades
in both ethnic groups.<b> </b>Strategies for screening and optimal
management of CM and depression particularly in early-onset T2DM may result in
a lower cardiovascular risk. </p>