Factors associated with stroke, myocardial infarction, ischemic heart disease, unstable angina, or mortality in patients from real world clinical practice with newly-diagnosed type 2 diabetes and early glycemic control. (1st February 2018)

• Record Type: Journal Article
• Authors: Alatorre, Carlos I.; Hoogwerf, Byron J.; Deeg, Mark A.; Nelson, David R.; Hunter, Theresa M.; Ng, Wee Teck; Rekhter, Mark D.
• Is Part Of: Current medical research and opinion. Volume 34:Number 2(2018)
• Page Start: 337
• Page End: 343
• Publication Date: 2018-02-01
• Subjects: Cardiovascular events -- stroke -- myocardial infarction -- ischemic heart disease -- unstable angina -- mortality -- type 2 diabetes -- glycemic control -- real-world evidence; Clinical medicine -- Periodicals; Therapeutics -- Periodicals; 615.5
• DOI: 10.1080/03007995.2017.1396969
• Languages: English
• ISSNs: 0300-7995

Abstract

Abstract: Objectives: The objective of this study was to identify factors associated with stroke, myocardial infarction (MI), all-cause mortality, or a diagnosis of ischemic heart disease (IHD) or unstable angina (UA), among patients newly-diagnosed with type 2 diabetes (T2DM) with no recent history of cardiovascular (CV) events who rapidly achieve and maintain HbA1c ≤8.0%. Methods: Data were obtained from the Clinical Practice Research Datalink (CPRD) from January 1990 to December 2012. A nested case-control design was used with Cox proportional hazards analysis. Cases were identified by the first occurrence of stroke, MI, IHD, UA, or death within 5 years after HbA1c ≤ 8.0% was first reached (index date) following T2DM diagnosis. Controls were selected using a risk-set sampling approach and were matched 4:1 to cases using index date, exposure time, age, gender, and HbA1c at index date. Results: A total of 11, 426 T2DM patients met the inclusion criteria for cases. Of these, 5, 261 experienced a CV event. Stroke was the most frequent CV event (40%), followed by IHD (29%), MI (22%), and UA (9%). Mean HbA1c ≥7.0% over the length of exposure (vs 6.5 to <7.0%) was associated with an increased risk of stroke, MI, and IHD. The use of anti-platelet medications at baseline was also associated with increased risk of stroke (HR = 1.82 [CI = 1.60–2.06]), MI (HR = 1.67 [CI = 1.38–2.03]), and IHD (HR = 1.85 [CI = 1.57–2.17]). Mean HbA1c < 6.0% was associated with increased risk of stroke (HR = 1.29 [CI = 1.02–1.63]) and IHD (HR = 1.65 [CI = 1.25–2.19]). Use of nitrate medications at baseline was associated with increased risk of MI (HR = 2.83 [CI = 2.24–3.57]), IHD (HR = 4.32 [CI = 3.57–5.22]), and UA (HR = 10.38 [CI = 7.67–14.03]). Conclusions: Early and sustained HbA1c control between 6.5 and <7.0% appears to be an important modifiable factor that helps reduce CV risk in patients with newly-diagnosed T2DM in real-world clinical practice.