93% of patients with type 2 diabetes have a high or very high risk of fatal events such as heart attack or stroke within a decade. This is the conclusion of a study published in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC), in which researchers from the Sant Pau Research Institute- IIB Sant Pau have participated. In view of these data, the prevention of heart attacks and strokes in patients with type 2 diabetes treated in primary care should be an urgent priority.
The research, which analyzed data from nearly 375,000 people in Catalonia, also points out that “half of the patients in the very high risk group had no history of heart disease, which means that they would not be candidates to receive medication to prevent heart attacks and strokes,” according to Manuel Mata-Casas, researcher at the CIBER for Diabetes and Associated Metabolic Diseases (CIBERDEM) and the Jordi Gol University Institute for Primary Care Research (IDIAP Jordi Gol), and one of the coordinators of this work.
Researchers from the Sant Pau Research Institute – IIB Sant Pau, attached to CIBERDEM, and the Murcia Health Service, specifically from the Cartagena Casco Health Center and the Santa Lucía Hospital, both in Cartagena , Murcia, have also participated in the work.
This is a transversal study which used the database of the Information System for the Development of Research in Primary Care (SIDIAP), which includes 74% of the total population of Catalonia. The SIDIAP database contains anonymous and longitudinal patient information extracted from the electronic medical record system (e-CAP) used by all the primary care centers of the Catalan Institute of Health in Catalonia. The study population included 373,185 people over 18 years of age diagnosed with type 2 diabetes. The average age was 70.1 years and 45.2% were women. About 72% had high blood pressure, 45% were obese, 60% had high serum cholesterol and 14% were current smokers.
Probability of suffering a fatal event in 10 years
The researchers calculated the likelihood that each participant would have a heart attack or fatal stroke within 10 years using categories in the European Society of Cardiology (ESC) guidelines on diabetes and cardiovascular disease. The three categories are: very high risk (above 10%), high risk (between 5% and 10%), and moderate risk (below 5%). To be classified as very high risk, patients must have established cardiovascular disease (e.g., heart attack or previous stroke) or other conditions that threaten their health, such as severe kidney failure or diabetic retinopathy, or at least three cardiovascular risk factors (advanced age, high blood pressure, high serum cholesterol, smoking, obesity).
More than half of the participants (53.4%) were at very high risk of fatal cardiovascular events. This observation was more frequent in men (55.6%) than in women (50.7%). About 39.6% were classified as high risk and only 7% had a moderate risk of dying from a heart attack or stroke within 10 years.
Cardiovascular risk in Mediterranean populations
“To our knowledge, this study on almost 375,000 people from a well validated population-based database illustrates the situation in the Mediterranean for the first time. Traditionally, cardiovascular risk in the region has been lower than in central and northern Europe or the United States, so our results should generate concern and a call to action to prevent heart attacks and strokes in people with type 2 diabetes in primary care,” Dr. Mata-Casas said.
“These findings, in a primary care setting, should drive the implementation of integrated care. Healthy behaviors are the cornerstone of preventing cardiovascular disease and should be combined with control of blood glucose, serum cholesterol, and blood pressure. Family physicians and nurses should agree on treatment goals with patients, taking into account their characteristics and preferences,” he concludes.
Link to the reference article:
Cebrián-Cuenca A, Mata-Cases M, Franch-Nadal J, et al. Half of patients with type 2 diabetes mellitus are at very high cardiovascular risk according to the ESC/EASD categories: data from a large Mediterranean population. Eur J Prev Cardiol. 2020. doi:10.1093/eurjpc/zwaa073.