Prophylactic CV medication appears to lower MI, death risk in diabetes without prior CVD
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Residents of Denmark with diabetes and no prior CVD experienced a 61% risk reduction for MI and a 41% for death from 1996 to 2011, according to data presented at the virtual European Society of Cardiology Congress.
Christine Gyldenkerne, MD, of the department of cardiology at Aarhus University Hospital, Denmark, said during the presentation that these improvements coincided with increased use of prophylactic CV medications.
“Our results suggest that when patients are diagnosed with type 2 diabetes, starting medications to prevent cardiovascular disease has a substantial impact on the risk of heart attacks and premature death,” Gyldenkerne said in a press release.
For this nationwide cohort study, investigators included all residents of Denmark with a first-ever prescription of a glucose-lowering drug from 1996 to 2011 and no history of CVD and matched them 1:5 with the general population for age and sex to compare the incidence of MI and mortality between groups. Participants were followed for 7 years. Researchers also evaluated trends in prophylactic CV medication use.
Investigators observed that from 1996 to 2011, the 7-year incidence of MI among patients with diabetes dropped from 6.9% to 2.8% (HR = 0.39; 95% CI, 0.37-0.41).
The risk difference for MI decreased from 3.2% to 0.6% between the diabetes group and the matched cohort during the study period.
Moreover, the 7-year incidence of mortality among patients with diabetes dropped from 28.8% in 1996 to 16.6% in 2011 (HR = 0.59; 95% CI, 0.57-0.6) and the risk difference for mortality dropped from 9.7% to 4.5% between the diabetes group and the matched cohort.
“Our study suggests that there may be room for further improvements,” Gyldenkerne said during the presentation. “These include increased use of statins, as only around 60% of patients with diabetes used statins; increased use of antihypertensive treatment; add on of new medications, such as ezetimibe, SGLT2 inhibitors and GLP-1 analogs; and lifestyle changes may also be beneficial in reducing cardiovascular risk in patients with newly diagnosed type 2 diabetes and no previous cardiovascular disease.”
In the study population, use of statins increased from 5% in 1996 to 59% in 2011, use of angiotensin II receptor blockers increased from 5% to 21% and use of aspirin increased from 18% to 27%.
“In addition to the use of preventive medications, other factors may have influenced the likelihood of heart attack and premature death,” Gyldenkerne said in the release. “For example, stricter control of diabetes and lifestyle changes such as smoking cessation, physical activity and healthier food may have contributed to the improved prognosis.”
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Gyldenkerne C, et al. Late-breaking science in coronary artery disease. Presented at: European Society of Cardiology Congress; Aug. 29-Sept. 1, 2020 (virtual meeting).
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