CV complications impact survival in elderly type 2 diabetes patients
medwireNews: Cardiovascular (CV) complications, and heart failure in particular, are strongly associated with poor survival in elderly patients with type 2 diabetes, French observational study data show.
Among the 987 consecutive patients (median age 77 years) with type 2 diabetes enrolled into the multicentre GERODIAB study, more than half (53%) had at least one CV complication at study entry, Jean-Pierre Le Floch (Villecresnes Medical Hospital) and colleagues report.
After 5 years, this proportion had increased to two-thirds (68%).
The most common CV complication was coronary heart disease, which increased from 30% to 41% during the course of the study, followed by vascular disease of the lower limbs, increasing from 25% to 35%, and vascular disease of the cerebral vessels, which increased from 15% to 26%.
Heart failure was less common, occurring in 9% at study entry, but its frequency more than doubled, to 20%, during follow-up.
The researchers say that the large increase in the rate of heart failure “underlines the influence of diabetes on cardiovascular events despite up-to-date preventive treatment.” Indeed, 90% of patients were receiving CV drugs at study entry, increasing to 95% after 5 years.
During follow-up, 207 (21%) participants died, with CV disease the most common cause of death, recorded in 34% of cases.
Le Floch and team report in Diabetes Care that there was a strong, statistically significant association between heart failure and poor survival. At 5 years, the survival rate was approximately 60% among the patients with heart failure, compared with around 80% in those without it.
Vascular disease of the lower limbs was also strongly linked to poor survival, whereas the associations were weaker, but still statistically significant, for coronary heart disease and vascular disease of cerebral vessels.
The investigators also found that amputation and foot wounds were strongly linked to survival, with 5-year survival rates of approximately 40% versus 80% in patients with and without amputation, respectively.
Among the CV complications described, heart failure was associated with the greatest risk for death on multivariate analysis, at a significant hazard ratio (HR) 1.96.
And this association was only slightly attenuated, to an HR of 1.92, when the analysis was further adjusted for other factors associated with survival such as individual and geriatric factors and other complications of diabetes.
Le Floch et al conclude that their findings should be “considered with caution, because many treatments can be used to improve the progression of coronary heart disease and/or vascular diseases, whereas heart failure is not so easy to improve or prevent.”
They add: “Interventional studies designed to prevent and/or to improve heart dysfunction should be performed in this population.”
By Laura Cowen
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