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Recurrent major CV events increased in patients with type 2 diabetes
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The risk for major cardiovascular events in patients with coronary artery disease was increased when the patients also had type 2 diabetes, according to recent findings.
However, type 2 diabetes does not appear to be a major risk factor for subsequent major CV events in all patients with symptomatic vascular disease, according to the researchers.
Frank L. Visseren, MD, PhD, of the University Medical Center Utrecht in the Netherlands, and colleagues evaluated 6,841 patients with clinically manifest vascular disease with type 2 diabetes (n = 1,155) and without (n = 5,686) to determine the effect of diabetes on recurrent major CV events. Participants were from the SMART cohort study.
The overall prevalence of type 2 diabetes was 22% in participants with polyvascular disease, 15% in those with peripheral arterial disease (PAD), 13% in participants with cerebrovascular disease and 11% in those with abdominal aortic aneurysm (AAA). The poorest glycemic control was found among participants with type 2 diabetes and PAD, with the highest fasting plasma glucose and HbA1c levels.
Researchers found a 21% risk for 5-year recurrent vascular events in participants with polyvascular disease, followed by 20% in AAA, 9% in cerebrovascular disease and PAD, and 7% in CAD.
Compared with patients with CAD without diabetes, those with CAD and diabetes had a higher risk for the combined vascular endpoint (HR = 1.67; 95% CI, 1.21-2.21). A higher risk for vascular endpoint also was found in those with cerebrovascular disease and diabetes (HR = 1.36; 95% CI, 0.9-2.07) but not for those with PAD and diabetes (HR = 1.42; 95% CI, 0.79-2.56) or polyvascular disease and diabetes (HR = 1.12; 95% CI, 0.83-1.5; P = 0.28 for interaction type 2 diabetes and location of vascular disease).
Participants with diabetes and CAD had increased risk for vascular mortality (HR = 1.55; 95% CI, 1-2.41) as did those with cerebrovascular disease (HR = 1.57; 95% CI, 0.91-2.7). All-cause mortality was increased in participants with PAD and diabetes (HR = 1.64; 95% CI, 1.01-2.68), cerebrovascular disease and diabetes (HR = 1.34; 95% CI, 0.9-1.98), and CAD and diabetes (HR = 1.29; 95% CI, 0.95-1.75).
“In conclusion, type 2 diabetes increased the risk of recurrent [major CV events] and mortality in patients with CAD but was not a risk factor in patients with [polyvascular disease],” the researchers wrote. “There is no convincing evidence that type 2 diabetes is a major risk factor for subsequent [major CV events] in all patients with clinically manifest vascular disease.” – by Amber Cox
Disclosure: Visseren reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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