Existing CV disease confers high short-term vascular risk in type 2 diabetes
medwireNews: People with type 2 diabetes are more likely to experience cardiovascular (CV) events, particularly myocardial infarction (MI), within 3 years of starting glucose-lowering therapy if they have pre-existing ischemic heart disease (IHD), research shows.
The study, which included 260,070 first-time glucose-lowering drug users from Sweden, also found that the impact of age at first treatment varied according to whether or not the individuals had a history of IHD, defined as MI, unstable angina, or stable angina pectoris.
“Our findings suggest that intense risk prevention should be the key strategy in the management of [type 2 diabetes] patients, especially for younger patients, including both encouragement for positive lifestyle changes and prescription of secondary preventive drug therapy with antiplatelet therapy and statins,” Lars Hasvold (AstraZeneca Nordic, Oslo, Norway) and co-authors write in BMJ Open.
They add: “Ideally, to reduce CV outcome and progression of [type 2 diabetes], younger [type 2 diabetes] patients with IHD should be offered participation in guideline-recommended risk reduction programmes.”
Among the study participants, 85% had no history of IHD, 6% had IHD without prior MI, and 9% had IHD with MI.
During 3 years of follow-up, the cumulative incidence of the primary composite CV outcome (MI, stroke or CV death) was 5.69% in the group without IHD, 13.08% in the group with IHD but no history of MI, and 18.83% in the group with IHD and previous MI.
When the data were adjusted to represent an “average” 63-year-old patient (mean age of the study population, plus mean sex, diabetes duration and rates of atrial fibrillation and heart failure), the corresponding 3-year incidence rates of the CV outcome were 4.78%, 5.85%, and 8.04%.
Hasvold and team note that the difference in the CV outcome was primarily driven by an increased 3-year adjusted cumulative incidence of MI among the patients with IHD versus those without (1.66 vs 3.09%).
When the investigators looked at the impact of age at first treatment on CV risk, they found that the relationship was “almost linear” among the patients without IHD, with CV risk increasing with increasing age.
By contrast, the relative CV risk increase associated with IHD was larger in younger patients (<60 years) than older patients. Furthermore, the relative CV risk in these patients did not begin to increase with age until after the age of 65 years.
Hasvold et al conclude: “Our findings highlight that there is a marked difference in CV and MI risk in different [type 2 diabetes] populations related to the presence and severity of IHD disease.”
They add: “Bearing in mind that we focus on difference in short-term risk in this paper […], and still see large differences in risk between the different study populations, it is inevitable that [type 2 diabetes] patients with a history of IHD should be carefully monitored and managed with a long-term perspective.”
By Laura Cowen
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