GLYCEMIC CONTROL AND CARDIOVASCULAR RISK FACTOR MANAGEMENT IN PATIENTS WITH DIABETES WITH AND WITHOUT CORONARY ARTERY DISEASE: INSIGHTS FROM THE DIABETES MELLITUS STATUS IN CANADA (DM-SCAN) SURVEY

Abstract Background Gender disparities in the management of dysglycaemia, defined as either impaired glucose tolerance (IGT) or type 2 diabetes (T2DM), in coronary artery disease (CAD) patients are a medical challenge. Recent data from two nationwide cohorts of patients suggested no gender difference as regards the risk for diabetes-related CV complications but indicated the presence of a gender disparity in risk factor management. The aim of this study was to investigate gender differences in screening for dysglycaemia, cardiovascular risk factor management and prognosis in dysglycemic CAD patients. Methods The study population (n = 16,259; 4077 women) included 7998 patients from the ESC-EORP EUROASPIRE IV (EAIV: 2012–2013, 79 centres in 24 countries) and 8261 patients from the ESC-EORP EUROASPIRE V (EAV: 2016–2017, 131 centres in 27 countries) cross-sectional surveys. In each centre, patients were investigated with standardised methods by centrally trained staff and those without known diabetes were offered an oral glucose tolerance test (OGTT). The first of CV death or hospitalisation for non-fatal myocardial infarction, stroke, heart failure or revascularization served as endpoint. Median follow-up time was 1.7 years. The association between gender and time to the occurrence of the endpoint was evaluated using Cox survival modelling, adjusting for age. Results Known diabetes was more common among women (32.9%) than men (28.4%, p < 0.0001). OGTT (n = 8655) disclosed IGT in 17.2% of women vs. 15.1% of men (p = 0.004) and diabetes in 13.4% of women vs. 14.6% of men (p = 0.078). In both known diabetes and newly detected dysglycaemia groups, women were older, with higher proportions of hypertension, dyslipidaemia and obesity. HbA1c was higher in women with known diabetes. Recommended targets of physical activity, blood pressure and cholesterol were achieved by significantly lower proportions of women than men. Women with known diabetes had higher risk for the endpoint than men (age-adjusted HR 1.22; 95% CI 1.04–1.43). Conclusions Guideline-recommended risk factor control is poorer in dysglycemic women than men. This may contribute to the worse prognosis in CAD women with known diabetes.

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Antithrombotic therapy and revascularisation strategies in people with diabetes and coronary artery disease

European Journal of Preventive Cardiology ◽

10.1177/2047487319880045 ◽

2019 ◽

Vol 26 (2_suppl) ◽

pp. 92-105 ◽

Cited By ~ 1

Author(s):

Bianca Rocca ◽

Andrea Rubboli ◽

Francesco Zaccardi

Keyword(s):

Diabetes Mellitus ◽

Coronary Artery Disease ◽

Cardiovascular Risk ◽

Coronary Artery ◽

Antiplatelet Drug ◽

Chronic Coronary Artery Disease ◽

Patients With Diabetes ◽

Artery Disease ◽

Diabetes Patients

Background Diabetes mellitus, largely type 2, affects nearly 10% of the global adult population according to the World Health Organization. Diabetes is an independent risk factor for atherosclerotic cardiovascular diseases, including coronary artery disease. Diabetes patients experience a two to three-fold increased incidence of coronary artery disease, despite improved metabolic control and management of other cardiovascular risk factors. Discussion Platelet abnormalities and activation as well as reduced antiplatelet drug responsiveness characterise diabetes mellitus. Mechanisms linking diabetes to platelet and vascular abnormalities, atherogenesis and atherosclerotic cardiovascular disease are still only partially known, highlighting the unique complexity of the pro-atherogenic clinical scenario and its treatment. Consistently, a higher residual cardiovascular risk characterises patients with diabetes compared with those without, in spite of improved antiplatelet and antithrombotic treatment combinations. Randomised clinical trials aimed at optimising antiplatelet treatment specifically in patients with diabetes are lacking, both in acute and chronic coronary artery disease settings. Thus, patients with diabetes are treated with regimens validated in studies including only variable proportions of diabetes patients. Myocardial revascularisation appears to confer a comparable relative benefit between diabetes patients and patients without diabetes, and generally coronary artery bypass grafting has a better outcome in diabetes mellitus versus peripheral coronary intervention. New glucose-lowering drugs have been shown to reduce the incidence of major cardiovascular events in secondary prevention. Type 1 diabetes mellitus remains less explored than type 2 in this context. Conclusion Diabetes-tailored antithrombotic strategies in acute and chronic coronary artery disease remain an unmet clinical need, requiring ad-hoc trials and precision pharmacological strategies.

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The E-selectin S128R polymorphism is not a risk factor for coronary artery disease in patients with diabetes mellitus type 2

Thrombosis Research ◽

10.1016/j.thromres.2003.10.018 ◽

2003 ◽

Vol 112 (1-2) ◽

pp. 47-50 ◽

Cited By ~ 15

Author(s):

Georg Endler ◽

Markus Exner ◽

Marianne Raith ◽

Rodrig Marculescu ◽

Christine Mannhalter ◽

...

Keyword(s):

Diabetes Mellitus ◽

Coronary Artery Disease ◽

Risk Factor ◽

Coronary Artery ◽

Diabetes Mellitus Type 2 ◽

Diabetes Mellitus Type ◽

Patients With Diabetes ◽

Artery Disease

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Features of diabetes mellitus in very elderly patients

Medical alphabet ◽

10.33667/2078-5631-2019-1-9(384)-13-19 ◽

2019 ◽

Vol 1 (9) ◽

pp. 13-19

Author(s):

S. V. Topolyanskaya ◽

T. M. Kolontai ◽

O. N. Vaculenko ◽

L. I. Dvoretski

Keyword(s):

Diabetes Mellitus ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Elderly Patients ◽

Very Elderly ◽

Younger Patients ◽

Patients With Diabetes ◽

Artery Disease

Modern concepts about features of diabetes mellitus in very elderly patients are described in the article. Special attention to the therapeutic methods of management of very elderly patients with diabetes mellitus has been devoted. The results of diabetes mellitus study in patients with coronary artery disease older than 75 years in comparison with younger patients are presented.

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