Baseline Cardiovascular Risk Factor Control in Patients With Type 2 Diabetes and Coronary Disease Versus Stroke: Secondary Analysis of Cardiovascular Outcome Trials

Author:

Balasubramanian Priyadarshini1ORCID,Kernan Walter N.2ORCID,Sheth Kevin N.3ORCID,Ofstad Anne Pernille45ORCID,Rosenstock Julio6ORCID,Wanner Christoph7ORCID,Zinman Bernard8,Mattheus Michaela9ORCID,Marx Nikolaus10ORCID,Inzucchi Silvio E.11ORCID

Affiliation:

1. Section of Endocrinology, Department of Medicine (P.B.), Yale School of Medicine, New Haven, CT.

2. Section of General Internal Medicine, Department of Medicine (W.N.K), Yale School of Medicine, New Haven, CT.

3. Department of Neurology (K.N.S), Yale School of Medicine, New Haven, CT.

4. Boehringer Ingelheim Norway KS, Asker (A.P.O.).

5. Oslo Diabetes Research Center, Norway (A.P.O.).

6. Velocity Clinical Research at Medical City, Dallas, TX (J.R.).

7. Würzburg University Clinic, Germany (C.W.).

8. Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, ON, Canada (B.Z.).

9. Boehringer Ingelheim Pharma GmbH & Co KG, Germany (M.M.).

10. Department of Internal Medicine, University Hospital; RWTH Aachen University, Germany (N.M.).

11. Section of Endocrinology, Department of Medicine (S.E.I), Yale School of Medicine, New Haven, CT.

Abstract

BACKGROUND: Patients with type 2 diabetes (T2D) and cardiovascular disease are at increased risk for recurrent ischemic events. Cardiovascular risk factor control is vital for secondary prevention, but how this compares among individuals with different T2D macrovascular complications is unknown. We aimed to determine if there might be differences in risk factor control in patients with T2D with previous stroke versus coronary artery disease (CAD). METHODS: Cross-sectional analyses were performed on 12 856 patients with T2D with prior history of stroke with or without CAD from 3 diabetes cardiovascular outcome trials: CARMELINA (The Cardiovascular and Renal Microvascular Outcome Study With Linagliptin), EMPA-REG OUTCOME (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients), and CAROLINA (The Cardiovascular Outcome Study of Linagliptin vs Glimepiride in Type 2 Diabetes). Risk factors at baseline assessed included dyslipidemia, hypertension, smoking, and current antiplatelet/anticoagulant therapy. Control, respectively, was defined as LDL (low-density lipoprotein)-C <100 mg/dL or statin use, systolic blood pressure <140 and diastolic blood pressure <90 mm Hg, not currently smoking, and use of an antiplatelet/anticoagulant medication. The odds ratio of 3 to 4 (or good) versus 0 to 2 (or suboptimal) risk factors controlled was analyzed by logistic regression models. RESULTS: The odds for good versus suboptimal risk factor control in patients with CAD alone was higher than in those with stroke alone across all 3 trials odds ratios (95% CI): CARMELINA, 2.05 (1.67–2.51), EMPA-REG OUTCOME, 2.50 (2.10–2.99), and CAROLINA, 1.63 (1.21–2.20). The respective odds ratios were lower (and rendered nonsignificant in CAROLINA) when cardiovascular risk factor control in patients with both CAD and stroke were compared with those with stroke alone: CARMELINA, 1.45 (1.13–1.87); EMPA-REG OUTCOME, 1.62 (1.25–2.08); and CAROLINA, 1.16 (0.74–1.83). CONCLUSIONS: In contemporary populations of patients with T2D, there was significant discordance in control of cardiovascular risk factors between patients with stroke versus CAD, with the former having less optimal control. The intermediate results in patients with both CAD and stroke suggest that these differences could be related at least in part to clinician factors. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifiers: NCT01243424, NCT01131676, NCT01897532.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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