Atherosclerotic Cardiovascular Disease (ASCVD) merupakan komplikasi utama pada pasien Diabetes Melitus Tipe 2 (DMT2) dan menjadi penyebab utama morbiditas serta mortalitas pada populasi ini. Namun, bukti mengenai hubungan ASCVD dengan kematian pasien DMT2 di Indonesia masih terbatas. Penelitian ini bertujuan menganalisis hubungan ASCVD dengan kematian pasien DMT2 di Indonesia menggunakan Data Sampel Kontekstual DM BPJS Kesehatan periode 2015–2022. Penelitian ini menggunakan desain kohort retrospektif terhadap 6.189 pasien DMT2 yang pertama kali terdiagnosis pada tahun 2015 dan diikuti hingga tahun 2022. Analisis survival dilakukan menggunakan metode Kaplan-Meier dan uji log-rank. Hubungan ASCVD dengan kematian dianalisis menggunakan regresi Cox proportional hazards. Interaksi antara ASCVD dan status gagal jantung dievaluasi untuk menilai adanya modifikasi efek. Karena ditemukan interaksi yang signifikan, analisis lanjutan dilakukan secara terpisah pada kelompok dengan dan tanpa gagal jantung serta dikontrol oleh penyakit ginjal kronis (CKD) dan wilayah tempat tinggal. Hasil penelitian menunjukkan bahwa 710 pasien (11,47%) memiliki ASCVD. Proporsi kematian pada kelompok ASCVD lebih tinggi dibandingkan kelompok tanpa ASCVD (14,79% vs 11,53%). Terdapat perbedaan cumulative survival probability yang bermakna antara pasien DMT2 dengan ASCVD dan tanpa ASCVD (77,65% vs 80,36%; p=0,0407). Pada pasien tanpa gagal jantung, ASCVD berhubungan dengan peningkatan hazard kematian sebesar 1,36 kali dibandingkan pasien tanpa ASCVD (aHR=1,36; 95% CI: 1,00–1,86). Sementara itu, pada pasien dengan gagal jantung diperoleh aHR sebesar 0,76 (95% CI: 0,58–1,01). Temuan ini menunjukkan bahwa hubungan ASCVD dengan kematian pasien DMT2 berbeda menurut status gagal jantung. Diperlukan penguatan deteksi dini dan pengelolaan ASCVD secara komprehensif pada pasien DMT2 untuk meningkatkan ketahanan hidup dan menurunkan risiko kematian.

Atherosclerotic Cardiovascular Disease (ASCVD) is a major complication among patients with Type 2 Diabetes Mellitus (T2DM) and a leading cause of morbidity and mortality in this population. However, evidence regarding the association between ASCVD and mortality among patients with T2DM in Indonesia remains limited. This study aimed to analyze the association between ASCVD and mortality among patients with T2DM in Indonesia using the BPJS Kesehatan Diabetes Mellitus Contextual Sample Data from 2015–2022. A retrospective cohort study was conducted involving 6,189 patients with T2DM who were newly diagnosed in 2015 and followed until 2022. Survival analysis was performed using the Kaplan–Meier method and log-rank test. The association between ASCVD and mortality was assessed using Cox proportional hazards regression. The interaction between ASCVD and heart failure status was evaluated to assess effect modification. Because a significant interaction was identified, subsequent analyses were conducted separately among patients with and without heart failure, while adjusting for chronic kidney disease (CKD) and residential area. The results showed that 710 patients (11.47%) had ASCVD. The proportion of deaths was higher among patients with ASCVD than among those without ASCVD (14.79% vs. 11.53%). A significant difference in cumulative survival probability was observed between patients with and without ASCVD (77.65% vs. 80.36%; p=0.0407). Among patients without heart failure, ASCVD was associated with a 1.36-fold higher hazard of mortality compared with those without ASCVD (aHR=1.36; 95% CI: 1.00–1.86). In contrast, among patients with heart failure, the adjusted hazard ratio was 0.76 (95% CI: 0.58–1.01). These findings indicate that the association between ASCVD and mortality among patients with T2DM differs according to heart failure status. Strengthening early detection and comprehensive management of ASCVD in patients with T2DM is needed to improve survival and reduce mortality risk.