medwireNews: A Spanish cross-sectional study suggests that a substantial proportion of people with type 2 diabetes are at very high risk for fatal cardiovascular (CV) events and could be considered as coronary artery disease (CAD) equivalent.”
“The results we present here might have significant implications for clinical practice,” say Ana Cebrián‑Cuenca (Primary Health Care Center Cartagena Casco, Spain) and colleagues in a letter published in the European Journal of Preventive Cardiology.
Data from 168,478 women and 204,707 men with type 2 diabetes were obtained from the SIDIAP primary care database in Catalonia. The mean age of the total group was 70.1 years, 72% had hypertension, 45% were obese, 60% presented dyslipidemia, and 14% were current smokers.
Cebrián‑Cuenca et al report that 53.4% of the total study population (50.7% of the women and 55.6% of the men) were at very high risk for fatal CV events, defined as a 10-year risk of more than 10% according to European Society of Cardiology risk categories. There were also 39.6% of people categorized as being at high risk (5–10% 10-year risk), meaning that a total of 93% people were at high or very high risk for fatal CV events.
They also found that 50% of people with very high CV risk did not have prior established CV disease (including coronary heart disease, stroke, peripheral arteriopathy, and heart failure). In the overall study population, only 26.7% of people with type 2 diabetes had prior CV disease.
In all, 36.4% of people without established CV disease showed very high CV risk, and these people “should be considered as CAD equivalent patients,” say the authors.
Moreover, because more than half of the participants were at very high CV risk, “[o]ne might argue in consequence, albeit provocative, that most of our [type 2 diabetes] patients are ‘CAD equivalent’,” they add.
In spite of this elevated risk, study co-author Manel Mata-Cases (Primary Health Care Center La Mina, Barcelona, Spain) pointed out that because a large proportion of the study participants had no prior CV disease, “they would not be receiving medications to prevent heart attacks and strokes.”
Writing in a press release, he said: “These findings in a primary care setting should fuel the implementation of integrated care.
“Healthy behaviors are the cornerstone of preventing cardiovascular disease and need to be combined with control of blood glucose, serum cholesterol, and blood pressure. [Primary care providers] and nurses should agree treatment objectives with patients considering their characteristics and preferences.”
Eur J Prev Cardiol 2020; doi:10.1093/eurjpc/zwaa073
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