Global undertreatment of patients with type 2 diabetes and CVD
medwireNews: Less than one-third of patients with type 2 diabetes and cardiovascular disease (CVD) are receiving optimal care for secondary prevention of cardiovascular events, suggests an analysis of data from the TECOS trial.
Neha Pagidipati (Duke University School of Medicine, Durham, North Carolina, USA) and study co-authors assessed whether 13,616 trial participants from 38 countries achieved five secondary prevention parameters for CVD: aspirin use; lipid control (low density lipoprotein cholesterol <70 mg/dL or statin therapy); blood pressure control (<140/90 mmHg); angiotensin-converting enzyme inhibitor (ACE) or angiotensin receptor blocker (ARB) use; and nonsmoking status.
The researchers found that only 29.9% of the participants achieved all five secondary prevention measures at baseline, although nearly three-quarters (71.8%) had at least four parameters.
Blood pressure was the least frequently achieved measure, with only 57.9% of participants reaching the target at baseline, whereas the majority of patients (88.6%) were nonsmokers.
These findings suggest that “[p]atients with diabetes and CVD are still being undertreated globally with respect to secondary prevention, and especially with regard to blood pressure control,” write the researchers in Circulation.
The team identified a number of factors associated with secondary prevention; a greater proportion of men than women achieved all five parameters (31.5 vs 26.1%), as did those with a history of coronary artery disease (CAD) versus cerebrovascular disease or peripheral artery disease (33.8 vs 23.6 vs 20.2%). Similarly, patients with CAD were significantly more likely to be on aspirin therapy, have lipid control, take ACE inhibitors or ARBs, and have blood pressure control than those without CAD.
In accordance with previous studies, patients with a higher secondary prevention score at baseline were more likely to have improved outcomes over a median 3 years of follow-up than those with lower scores.
Compared with patients who had two or fewer secondary prevention measures at baseline, those with three measures had a 24% reduced risk for the primary composite outcome of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina after adjustment for potential confounders, while participants with four measures had a 37% reduced risk and those with five had a 40% reduced risk.
Pagidipati and colleagues also identified geographical variations in the achievement of secondary prevention measures, with North America having the highest proportion of participants achieving all five measures, at 41.2%, and Eastern Europe and Latin America having the lowest proportion, at 24.7% and 25.3%, respectively.
Although the authors identified “substantial” variation between countries, they note that their retrospective study results may be subject to residual confounding and regional differences and “should be considered exploratory.”
Nevertheless, they conclude: “These gaps in care provide clear opportunities for improvement in this high-risk population, and recognition of the need for greater secondary preventive care in patients with diabetes and known CVD is critical to improve outcomes going forward.”
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