[Secondary prevention of ischemic heart disease in diabetics in clinical practice]

Diabetes is an indication for particularly careful risk factors management in ischaemic heart disease patients.

The aim of the study was to assess the implementation of guidelines on secondary prevention of ischaemic heart disease in diabetics.

We reviewed hospital records of 1051 consecutive patients at age < or = 70 years with discharge diagnosis of acute myocardial infarction, unstable angina, percutaneous coronary intervention or coronary artery bypass surgery who were hospitalized in three university and in three community cardiac departments serving the area of the city. The follow-up interview took place 6-18 months after discharge.

Out of 1051 (754 men and 297 women; mean age 57.1 +/- 8.4 years) study participants 160 (15.2%) were diagnosed as having diabetes. ACE inhibitors were prescribed at discharge more often (73.1% vs 47.6%; p < 0.0001) whereas beta-blockers (54.4% vs 66,0%; p < 0.01) and lipid-lowering drugs (25.0% vs 35.9%; p < 0.01) less often in diabetics compared to non-diabetics. One year after discharge diabetics smoked less frequently compared to non-diabetics (9.8% vs 17.2%; p < 0.05). No significant difference was found in the prevalence of high blood pressure, high total and LDL cholesterol levels, low HDL cholesterol level and high triglycerides level in diabetic and non-diabetic patients. The prevalence of obesity increased after hospitalization in both groups. ACE inhibitors were used more often (61.5% vs 44.3%; p < 0.001) whereas lipid-lowering drugs less often (27.1% vs 39.8%; p < 0.01) in diabetics compared to non-diabetics. Diabetes was not independently related to the frequency of lipid-lowering drug use in patients with hypercholesterolemia.

Insufficient control of risk factors and too low prescription rate of secondary prevention drugs were found both in diabetic and non-diabetic patients. There is a need to intensify secondary prevention, especially in patients with diabetes.