Diabetes and cardiovascular events in high-risk patients: Insights from a multicenter registry in a middle-income country. (May 2017)

• Record Type: Journal Article
• Authors: Schaan, Beatriz D.; de Figueiredo Neto, Jose Albuquerque; Moreira, Leila Beltrami; Ledur, Priscila; Mattos, Luiz Alberto P.; Magnoni, Daniel; Precoma, Dalton Bertolim; Machado, Carlos Alberto; da Silva Brasileiro, Antônio Luiz; Pena, Felipe Montes; Harzheim, Erno; Montenegro, Sérgio; Bernardez-Pereira, Sabrina; Damiani, Lucas P.; Consolim-Colombo, Fernanda M.; de Paola, Angelo Amato Vicenzo; Andrade, Jadelson; Guimarães, Jorge Ilha; Berwanger, Otávio
• Is Part Of: Diabetes research and clinical practice. Volume 127(2017)
• Page Start: 275
• Page End: 284
• Publication Date: 2017-05
• Subjects: Epidemiology -- Diabetes mellitus -- Cardiology -- Mortality; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2017.03.021
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: Diabetes is not a cardiovascular risk equivalent. Not all patients with diabetes should be treated as secondary prevention. Individual risk assessment in patients with diabetes is required. The use of insulin, was per se associated with higher cardiovascular risk in patients with diabetes. Abstract: Aims: The aim of this study was to determine the rate of major clinical events and its determinants in patients with previous cardiovascular event or not, and with or without diabetes from a middle-income country. Methods: REACT study is a multicenter registry conducted between July 2010 and May 2013 in Brazil. Patients were eligible if they were over 45 years old and high cardiovascular risk. Patients were followed for 12 months; data were collected regarding adherence to evidence-based therapies and occurrence of clinical events (all-cause mortality, non-fatal cardiac arrest, myocardial infarction, or stroke). Results: A total of 5006 subjects was included and analyzed in four groups: No diabetes and no previous cardiovascular event, n = 430; diabetes and no previous cardiovascular event, n = 1138; no diabetes and previous cardiovascular event, n = 1747; and diabetes and previous cardiovascular event, n = 1691. Major clinical events in one-year follow-up occurred in 332 patients. A previous cardiovascular event was associated with a higher risk of having another event in the follow-up (HR 2.31 95% CI 1.74–3.05, p < 0.001), as did the presence of diabetes (HR 1.28 95% CI 1.10–1.73, p = 0.005). In patients with diabetes, failure to reach HbA1c targets was related to poorer event-free survival compared to patients with good metabolic control (HR 1.70 95% CI 1.01–2.84, p = 0.044). Conclusions: In Brazil, diabetes confers high risk for major clinical events, but this condition is not equivalent to having a previous cardiovascular event. Moreover, not so strict targets for HbA1c in patients with diabetes and previous cardiovascular events might be considered.