Prevalence of diabetes and impact on cardiovascular events and mortality in patients with chronic coronary syndromes, across multiple geographical regions and ethnicities

Abstract

Background In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity. Methods and results CLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure. Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest. Conclusion In patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes. ClinicalTrials identifier ISRCTN43070564

Identification of plasma proteomic markers underlying polygenic risk of type 2 diabetes and related comorbidities

“…The effect sizes of these scores on the circulating protein levels were all positively correlated with that of the PGS T2D_gw (p-value < 0.05, Figure 1C ), supporting the epidemiological observation that cardiometabolic diseases are highly interconnected. 34,35 However, for select proteins, the directions of effect of the T2D T2D_gw on circulating levels were in fact opposite when compared to the effects of another PGS (e.g., the effect of PGS T2D_gw and PGS BMI on TIMP4 levels, see Supplementary Information , supplementary figure 18, and Supplementary Table 8 ), likely reflecting more complicated relationships such as compensatory responses. 36–38 In the case of the partitioned scores, the correlation patterns seem to point to proteomic mechanisms that explain their differential associations with T2D comorbidities.…”

A cross‐sectional study of the prevalence and clinical management of atherosclerotic cardiovascular diseases in patients with type 2 diabetes across the Middle East and Africa (PACT‐MEA): Study design and rationale

“…While there are studies that have established the prevalence of T2D in the Middle East and Africa, [21][22][23][24][25][26] there is limited information on the prevalence of eASCVD or on high/very high ASCVD risk in patients with T2D in this region. 3,[27][28][29][30][31] The CAPTURE study estimated the prevalence of ASCVD among patients with T2D across 13 countries from five continents and showed that one in three adults with T2D have established CVD, of which 9/10 had ASCVD.…”

Vascular cell adhesion molecule‑1 levels in patients with coronary artery disease with type 2 diabetes mellitus

“…За даними реєстрів та рандомізованих клінічних випробувань, від 29 до 41% хворих на стабільну ішемічну хворобу серця (ІХС) мають цукровий діабет (ЦД) [1,2,3] Серед молекул адгезії, що експресуються в атеромі та опосередковують проникнення моноцитів і лімфоцитів до ендотелію та подальшу їх міграцію в атеросклеротичну бляшку, найбільша частка (82%) припадає на судинну молекулу клітинної адгезії 1 (Vascular cell adhesion molecule-1 (VCAM-1)), яка розглядається як хороший маркер для виявлення наявних атеросклеротичних уражень, а також для раннього виявлення активованого ендотелію з ризиком утворення бляшок [12]. У клінічних дослідженнях активно вивчається розчинна форма VCAM-1 (soluble VCAM-1 (sVCAM-1)), що вивільняється в судинне русло і вважається індикатором судинного запалення та активації ендотелію [13,14].…”