Aims
Data on glucose and cardiovascular disease (CVD) risk factor control among persons with type 2 diabetes mellitus (DM) according to insulin treatment status are lacking. We examined DM control, risk factors, and comorbidities among U.S. persons according to insulin treatment status.
Methods
In the U.S. National Health and Nutrition Examination Surveys 2003–2006, we examined in 10,637 adults aged ≥30 with type 2 DM the extent of control of A1c, LDL-C, HDL-C, triglycerides, and blood pressure (BP) and composite goal attainment by insulin use status.
Results
6.6% (n=889, projected to 14.3 million) had type 2 DM; of these, 22.9% were insulin users and 57.2% were treated only by other diabetes medications. Overall, 58.2% had an A1c<7% (53 mmol/mol) (insulin users 33.1%, non-insulin treated 66.1%, and 77.9% of those not on medication, p<0.0001). Overall, 44.2% were at a BP goal of <130/80 mmHg, 43.8% had an LDL-C<100 mg/dl (2.6 mmol/L), and 13.9% a BMI<25 kg/m2. Only 10.2% were simultaneously at A1c, LDL, and BP goals (5.4% of those on insulin).
Conclusions
U.S. adults with type 2 DM, especially those treated with insulin remain inadequately controlled for A1c and CVD risk factors and have a high prevalence of comorbidities.
Diabetes mellitus (DM) is strongly related to an increased risk for coronary heart disease (CHD) and cardiovascular disease (CVD) which includes CHD, stroke, heart failure, myocardial infarction and peripheral arterial disease. [1][2][3] Persons with DM without prior myocardial infarction (MI) have been observed to have a similar risk for future CHD events to those without DM but who have a prior MI 2 and total mortality is also similar in persons with prior CVD without DM as compared with those with DM without CVD. 4,5 The Third Adult Treatment Panel of the National Cholesterol Education Program designated DM as a CHD risk equivalent, thus indicating such persons for aggressive low density lipoprotein-cholesterol (LDL-C) lowering as in persons with pre-existing CHD. 6 However, a recent meta-analysis of 13 studies involving 45,108 subjects shows many of those with DM to have lower CHD event rates than persons with known CHD; those with DM without prior myocardial infarction had a 43% lower risk of developing total CHD events compared with those without DM but with a previous myocardial infarction. 3 Also, we have previously reported among persons with metabolic syndrome that a significant proportion (>30%) are at low estimated CHD risk. 7 Thus, these observations raise question as to whether DM is typically a CHD or CVD risk equivalent.Accordingly, it was of interest in this study to examine the global CVD risk associated with DM in US persons with DM. We examined the 10 year risk of total CVD in US persons with diabetes using global risk assessment equations for total CVD across gender and ethnicity, by DM type and treatment, as well as examined risk factor differences and goal attainment by global risk categories.
Global cardiovascular disease risk assessment in United States adults with diabetes
Background
Left ventricular free wall rupture (LVFWR) is a rare complication after myocardial infarction and usually occurs 1 to 4 days after the infarct. Over the past decade, the overall incidence of LVFWR has decreased given the advancements in reperfusion therapies. However, during the COVID-19 pandemic, there has been a significant delay in hospital presentation of patients suffering myocardial infarctions, leading to a higher incidence of mechanical complications from myocardial infarctions such as LVFWR.
Case presentation
We present a case in which a patient suffered a LVFWR as a mechanical complication from myocardial infarction due to delay in seeking care over fear of contracting COVID-19 from the medical setting. The patient had been having chest pain for a few days but refused to seek medical care due to fear of contracting COVID-19 from within the medical setting. He eventually suffered a cardiac arrest at home from a massive inferior myocardial infarction and found to be in cardiac tamponade from a left ventricular perforation. He was emergently taken to the operating room to attempt to repair the rupture but he ultimately expired on the operating table.
Conclusions
The occurrence of LVFWR has been on a more significant rise over the course of the COVID-19 pandemic as patients delay seeking care over fear of contracting COVID-19 from within the medical setting. Clinicians should consider mechanical complications of MI when patients present as an out-of-hospital cardiac arrest, particularly during the COVID-19 pandemic, as delay in seeking care is often the exacerbating factor.
Angiographic SYNTAX score only weakly correlated with LCBI. It is of interest as well that high LCBI was also present in cases of low SYNTAX scores. The disparity between the degree of angiographic complexity and the amount of LCP supports postulated mechanisms of the adverse event propensity even in patients who demonstrate low angiographic complexity. Future studies are necessary to address the clinical significance of high LCBI in patients with low-to-intermediate angiographic complexity and their potential for PCI-related complications.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.