ObjectivesTo evaluate the risk profile, achievement of cardiometabolic goals, and frequency and optimal use of cardiovascular preventive therapies among nonagenarians with type 2 diabetes mellitus (T2DM). To investigate possible sex differences.Design and settingA cross-sectional population study of 11 645 persons aged ≥90 years with T2DM living in Madrid (Spain). Sociodemographic, clinical and therapy profiles were collected through electronic records in primary care. We considered antihypertensive therapy and lipid-lowering therapy to be optimal when known patients with hypertension with albuminuria received renin–angiotensin system blockers and statins had been prescribed for overt cardiovascular disease.ResultsThe prevalence of coronary artery disease was higher in males than in females (21.5% vs 12.6%, p<0.01), as was that of peripheral artery disease (8.5% vs 2.3%, p<0.01). However, the prevalence of cerebrovascular disease was similar in both sexes (16.5% vs 16%; p=0.44). Haemoglobin A1c was lower than 7% in 64.4% of cases, with female predominance in patients with known dementia (67.1% female vs 59.9% male; p<0.01). Antiplatelet therapy was significantly more frequent in males than in females (48.1% vs 44.3%; p<0.01), as were statins (43.2% vs 40.2%; p<0.01). Both in primary and in secondary prevention, rates for simultaneous achievement of the HbA1c, blood pressure, LDL-C goals were significantly lower among females (p<0.01). For each criterion of optimal use of cardiovascular preventive therapies, adherence was significantly better in males than in females.ConclusionOur study showed that the risk of cerebrovascular disease was similar in both male and female Spanish nonagenarians. Adherence was poorer in females for all criteria of optimal use of cardiovascular preventive therapies. Our findings indicate that the known sex differences in younger patients with T2DM persist in patients aged ≥90 years. There is considerable room for improvement in standards of preventive care in nonagenarians with T2DM, especially in females.

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Background: To analyze all-cause mortality and cardiovascular events in nonagenarians from a Mediterranean population.Methods: Primary Health Care (265 health centres)Participants: Primary health records of all the nonagenarians living in the Community of Madrid (N=59,423). We defined 4 groups according to prevalent type 2 diabetes mellitus and established cardiovascular disease: (1) type 2 diabetes mellitus (-), cardiovascular disease (-); (2) type 2 diabetes mellitus (-), cardiovascular disease (+); (3) type 2 diabetes mellitus (+), cardiovascular disease (-); and (4) type 2 diabetes mellitus (+), cardiovascular disease (+). Follow-up time was 2.5 years. Primary outcome: Cumulative incidence and the density incidence rates of all-cause mortality, non-fatal myocardial infarction, non-fatal stroke (combined they constituted the first composite primary outcome (CPO1)), and heart failure (similarly, combined with the previous they constituted CPO2). We evaluated the adjusted effect of groups classification on all-cause mortality (Cox regression). Results. Mean age was 93.3±2.8 years; 74.2% were women. Hypertension, dyslipidemia, heart failure, albuminuria and estimated glomerular filtration rate <60 mL/min/1.73m2 were significantly more prevalent in group 4 (type 2 diabetes mellitus (+), cardiovascular disease (+)) than in the other groups (all p values <0.001). We observed significantly higher rates of cumulative incidence of all-cause mortality, CPO1 and CPO2 in participants belonging to group 4 (all p values ≤0.001). People in group 2 (type 2 diabetes mellitus (-), cardiovascular disease (+)) presented higher rates of all-cause mortality, heart failure, CPO1 and CPO2 than people in group 3 (type 2 diabetes mellitus (+), cardiovascular disease (-)) (all p values ≤0.001). In the fully-adjusted model, prevalent type 2 diabetes mellitus plus established cardiovascular disease (group 4) independently predicted all-cause mortality (HR=1.48 (95% CI, 1.40 to 1.57) as compared to reference group 1 (type 2 diabetes mellitus (-), cardiovascular disease (-)) (p <0.01). Also, cardiovascular disease and type 2 diabetes mellitus alone showed significant HRs (1.13 and 1.14, respectively; both p values <0.01)).Conclusions. In Spanish nonagenarians, established cardiovascular disease and type 2 diabetes mellitus conferred modest all-cause mortality risks. The concurrent presence of both conditions conferred the highest all-cause mortality risk.