Diabetes and cardiovascular events in high-risk patients: Insights from a multicenter registry in a middle-income country

Schaan, Beatriz D.; Neto, José Albuquerque de Figueiredo; Moreira, Leila Beltrami; Ledur, Priscila dos Santos; Mattos, Luiz Alberto; Magnoni, Daniel; Précoma, Dalton Bertolim; Machado, Carlos A.; Brasileiro, Antônio Luiz da Silva; Pena, Felipe Montes; Harzheim, Erno; Montenegro, Sérgio Tavares; Bernardez‐Pereira, Sabrina; Damiani, Lucas Petri; Consolim‐Colombo, Fernanda Marciano; Paola, Ângelo A. V. de; Andrade, Jadelson Pinheiro de; Guimarães, Jorge Ilha; Berwanger, Otávio

doi:10.1016/j.diabres.2017.03.021

Cited by 17 publications

(11 citation statements)

References 33 publications

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“…There has been an extensive discussion in the literature on the associations of diabetes with heart disease and stroke [ 5 – 9 , 12 , 13 , 20 , 21 ]. However, the longitudinal progression of these conditions remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Progression of diabetes, heart disease, and stroke multimorbidity in middle-aged women: A 20-year cohort study

Mishra

Dobson

et al. 2018

PLoS Med

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BackgroundThe prevalence of diabetes, heart disease, and stroke multimorbidity (co-occurrence of two or three of these conditions) has increased rapidly. Little is known about how the three conditions progress from one to another sequentially through the life course. We aimed to delineate this progression in middle-aged women and to determine the roles of common risk factors in the accumulation of diabetes, heart disease, and stroke multimorbidity.Methods and findingsWe used data from 13,714 women aged 45–50 years without a history of any of the three conditions. They were participants in the Australian Longitudinal Study on Women's Health (ALSWH), enrolled in 1996, and surveyed approximately every 3 years to 2016. We characterized the longitudinal progression of the three conditions and multimorbidity. We estimated the accumulation of multimorbidity over 20 years of follow-up and investigated their association with both baseline and time-varying predictors (sociodemographic factors, lifestyle factors, and other chronic conditions).Over 20 years, 2,511 (18.3%) of the women progressed to at least one condition, of whom 1,420 (56.6%) had diabetes, 1,277 (50.9%) had heart disease, and 308 (12.3%) had stroke; 423 (16.8%) had two or three of these conditions. Over a 3-year period, the age-adjusted odds of two or more conditions was approximately twice that of developing one new condition compared to women who did not develop any new conditions. For example, the odds for developing one new condition between Surveys 7 and 8 were 2.29 (95% confidence interval [CI], 1.93–2.72), whereas the odds for developing two or more conditions was 6.51 (95% CI, 3.95–10.75). The onset of stroke was more strongly associated with the progression to the other conditions (i.e., 23.4% [95% CI, 16.3%–32.2%] of women after first onset of stroke progressed to other conditions, whereas the percentages for diabetes and heart disease were 9.9% [95% CI, 7.9%–12.4%] and 11.4% [95% CI, 9.1%–14.4%], respectively). Being separated, divorced, or widowed; being born outside Australia; having difficulty managing on their available income; being overweight or obese; having hypertension; being physically inactive; being a current smoker; and having prior chronic conditions (i.e., mental disorders, asthma, cancer, osteoporosis, and arthritis) were significantly associated with increased odds of accumulation of diabetes, heart disease, and stroke multimorbidity. The main limitations of this study were the use of self-reported data and the low number of events.ConclusionsStroke was associated with increased risk of progression to diabetes or heart disease. Social inequality, obesity, hypertension, physical inactivity, smoking, or having other chronic conditions were also significantly associated with increased odds of accumulating multimorbidity. Our findings highlight the importance of awareness of the role of diabetes, heart disease, and stroke multimorbidity among middle-aged women for clinicians and health-promotion agencies.

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Section: Discussionmentioning

confidence: 99%

Progression of diabetes, heart disease, and stroke multimorbidity in middle-aged women: A 20-year cohort study

Mishra

Dobson

et al. 2018

PLoS Med

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“…Moreover, Di Angelantonio et al in a meta-analysis of observational studies observed similar mortality risk for diabetic subjects and patients who had experienced a stroke previously [ 17 ]. Analysis of the multicenter REACT REGISTRY which was conducted between 2010 and 2013 in Brazil showed that diabetes was not a cardiovascular risk equivalent [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical features, management and mortality in diabetic and non-diabetic patients with heart failure – observations from the COMMIT-HF registry

Siedlecki

Szyguła‐Jurkiewicz

Pyka

et al. 2017

kitp

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IntroductionDiabetes mellitus (DM) and heart failure (HF) are two common diseases that often co-exist.AimTo explore clinical characteristics, management strategies and rates of 3-year mortality among diabetic and non-diabetic patients hospitalised in a highly specialized interventional cardiology centre.Material and methodsWe used data from COMMIT-HF (COnteMporary Modalities In Treatment of Heart Failure), which is a single-centre, observational, prospective registry of patients with symptomatic chronic systolic HF (LVEF < 35%). Data collected included demographics, clinical characteristics, medical history, inpatient therapies and procedures. Follow-up was based on the information acquired from the national health-care provider.ResultsWe analysed 1397 patients out of the total of 1798 patients included in the COMMIT-HF registry between 2009 and 2013. We identified 595 (42.6%) diabetic and 802 (57.4%) non-diabetic patients. Compared to patients without DM, patients with type 2 DM had a higher rate of comorbidity. Frequency of death in patients with DM during the 3-year follow-up was significantly higher than in patients without DM (199 (33.4%) vs. 163 (20.3%), p < 0.0001, respectively).ConclusionsIn the analysed HF population representing patients receiving typical, everyday clinical care, the prevalence of DM is 42.6%. Diabetes mellitus has deleterious effects on renal function and symptoms as assessed by the New York Heart Association functional class. DM remains associated with increased frequency of death in patients with HF, in spite of recent pharmacological and device-based advances in HF management.

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“…In that study, HbA1c targets of 8.0 and 7.0% were considered in patients without a previous cardiovascular event vs. those with a previous cardiovascular event [61]. …”

Section: Module 4: Management Of Hyperglycemiamentioning

confidence: 99%

Brazilian guidelines on prevention of cardiovascular disease in patients with diabetes: a position statement from the Brazilian Diabetes Society (SBD), the Brazilian Cardiology Society (SBC) and the Brazilian Endocrinology and Metabolism Society (SBEM)

Bertoluci

Moreira

Faludi

et al. 2017

Diabetol Metab Syndr

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BackgroundSince the first position statement on diabetes and cardiovascular prevention published in 2014 by the Brazilian Diabetes Society, the current view on primary and secondary prevention in diabetes has evolved as a result of new approaches on cardiovascular risk stratification, new cholesterol lowering drugs, and new anti-hyperglycemic drugs. Importantly, a pattern of risk heterogeneity has emerged, showing that not all diabetic patients are at high or very high risk. In fact, most younger patients who have no overt cardiovascular risk factors may be more adequately classified as being at intermediate or even low cardiovascular risk. Thus, there is a need for cardiovascular risk stratification in patients with diabetes. The present panel reviews the best current evidence and proposes a practical risk-based approach on treatment for patients with diabetes.Main bodyThe Brazilian Diabetes Society, the Brazilian Society of Cardiology, and the Brazilian Endocrinology and Metabolism Society gathered to form an expert panel including 28 cardiologists and endocrinologists to review the best available evidence and to draft up-to-date an evidence-based guideline with practical recommendations for risk stratification and prevention of cardiovascular disease in diabetes. The guideline includes 59 recommendations covering: (1) the impact of new anti-hyperglycemic drugs and new lipid lowering drugs on cardiovascular risk; (2) a guide to statin use, including new definitions of LDL-cholesterol and in non-HDL-cholesterol targets; (3) evaluation of silent myocardial ischemia and subclinical atherosclerosis in patients with diabetes; (4) hypertension treatment; and (5) the use of antiplatelet therapy.ConclusionsDiabetes is a heterogeneous disease. Although cardiovascular risk is increased in most patients, those without risk factors or evidence of sub-clinical atherosclerosis are at a lower risk. Optimal management must rely on an approach that will cover both cardiovascular disease prevention in individuals in the highest risk as well as protection from overtreatment in those at lower risk. Thus, cardiovascular prevention strategies should be individualized according to cardiovascular risk while intensification of treatment should focus on those at higher risk.

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Diabetes and cardiovascular events in high-risk patients: Insights from a multicenter registry in a middle-income country

Cited by 17 publications

References 33 publications

Progression of diabetes, heart disease, and stroke multimorbidity in middle-aged women: A 20-year cohort study

Progression of diabetes, heart disease, and stroke multimorbidity in middle-aged women: A 20-year cohort study

Clinical features, management and mortality in diabetic and non-diabetic patients with heart failure – observations from the COMMIT-HF registry

Brazilian guidelines on prevention of cardiovascular disease in patients with diabetes: a position statement from the Brazilian Diabetes Society (SBD), the Brazilian Cardiology Society (SBC) and the Brazilian Endocrinology and Metabolism Society (SBEM)

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