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Mild CAD increased CV event risk in patients with diabetes
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Patients with diabetes who have even mild coronary artery disease are as likely to experience a cardiovascular event as those with serious single-vessel obstructive disease, according to research presented at the annual meeting of the Radiological Society of North America.
“Our study suggests patients with diabetes with mild [CAD] have an increased risk of death compared to patients without [CAD],” Philipp Blanke, MD, radiologist at the University of British Columbia and St. Paul’s Hospital, told Endocrine Today. “Thereby, patients with mild disease face a similar relative risk for heart attack of major adverse heart events as diabetics with serious (obstructive) single-vessel disease.”
Philipp Blanke
Using data from the CONFIRM registry, Blanke and colleagues identified 1,823 patients (mean age, 61.7 years; 54.1% male) with diabetes from 16 centers who had cardiac CT angiography without prior CAD.
CAD based on cardiac CT angiography was defined as none (no stenosis), mild (1%-49% stenosis) and obstructive (≥50% stenosis severity); CAD severity was assessed per patient, per vessel and per segment.
The researchers used multivariable Cox proportional hazards models to estimate time to death. In a subgroup, time to major adverse CV event — defined as death, myocardial infarction, unstable angina or late coronary revascularization —also was estimated.
During a follow-up of approximately 5.2 years, 246 (13.5%) deaths occurred. Both per-patient obstructive (HR=2.1; 95% CI, 1.4-3.2) and nonobstructive (HR=2; 95% CI, 1.3-3.1) CAD were associated with death in a risk-adjusted analysis; mortality risk was similarly elevated with nonobstructive disease and single-vessel obstructive disease (P=.42).
The absence of CAD was associated with a low incident mortality rate (annualized rate=1.2%; 95% CI, 0.8-1.7). Major adverse CV event occurred frequently (295/973 patients, 30.3%) during the follow-up period; both per-patient obstructive (HR=10.4; 95% CI, 5.9-18.1) and nonobstructive (HR=4.9; 95% CI, 2.8-8.6) CAD were associated.
“Patients identified with having mild disease on CT may benefit from more aggressive medical therapy than they currently are receiving,” Blanke said. “However, this has to be investigated in prospective studies.” – by Allegra Tiver
For more information:
Blanke P. Abstract SSM03-04. Presented at: Radiological Society of North America Annual Meeting; Nov. 30-Dec. 5, 2014; Chicago.
Disclosure: Blanke reports no relevant financial disclosures.