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Risk factor modification in diabetic patients following angiographic identification of multi-vessel disease
Leia Hee1, Liza Thomas, Xinhui Ang
1Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.
Insights
Younger diabetic patients with multi-vessel disease (MVD) show poor risk factor management, particularly in glycemic control, despite MVD identification. Targeted education programs are crucial for this high-risk group.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Multi-vessel disease (MVD) is common in diabetic mellitus (DM) patients, but its impact on risk factor management remains understudied.
- Effective management of cardiovascular risk factors is critical for improving outcomes in diabetic patients with coronary artery disease.
Purpose of the Study:
- To investigate whether the identification of MVD in diabetic patients influences the management of key risk factors, specifically glycemic and lipid control.
- To assess the effectiveness of risk factor modification at one-year follow-up in diabetic patients with MVD, stratified by age.
Main Methods:
- A cohort of 227 diabetic patients with MVD identified via coronary angiography was analyzed.
- Glycated hemoglobin (HbA1c) and total cholesterol (TC) levels were measured at baseline and 1-year follow-up.
- Patients were categorized into four age groups: <55, 55-65, 66-75, and >75 years.
Main Results:
- Patients younger than 55 years exhibited the poorest glycemic control (highest HbA1c) and the lowest proportion achieving target levels at both baseline and 1-year follow-up.
- The 66-75 year age group demonstrated the best glycemic control and the highest proportion reaching target levels.
- Younger patients (<55 years) also showed the worst cholesterol control at 1-year, with a significant increase from baseline. Lower BMI correlated with improved HbA1c, while current smoking was paradoxically linked to better TC control.
Conclusions:
- Risk factor modification, particularly glycemic control, is suboptimal in younger diabetic patients with MVD one year after identification.
- There is a clear need for developing and implementing targeted educational and monitoring programs to enhance risk factor management in this vulnerable demographic.
Abstract:
There is little information on whether identification of multi-vessel disease (MVD) in patients with diabetic mellitus (DM) affects risk factor management. From 1125 consecutively screened patients between June 2006 and March 2010, we examined 227 diabetic patients with MVD on coronary angiography. Diabetic control and cholesterol levels were assessed by glycated haemoglobin (HbA1c) and total cholesterol (TC) respectively which were evaluated at baseline and at 1-year follow-up. Patients were grouped by age into <55(n=33), 55-65(n=75), 66-75(n=75) and >75(n=44). Target levels were defined as HbA1c<7% and TC<4.0 mmol/L. Patients <55 years had the highest HbA1c at 9.1[7.6-11.2]% with the lowest proportion of patients (n=3; 11.1%) within target at baseline, while 66-75 years had the best HbA1c at 7.1[6.4-7.8]% with the highest proportion (n=28, 45.2%) reaching target (p<0.0001). At 1-year, the poorest HbA1c control was again observed in the age <55 with fewer patients achieving target compared to the 66-75 age group (HbA1c: 8.5% vs 6.9%; % of patients at target: 20.7% vs 54.5%; p<0.0001). Furthermore, the group <55 years demonstrated the worst TC control at 1-year with a significant increase compared to the baseline TC (p=0.01). Patients with a lower body mass index (BMI) were likely to have an improvement in HbA1c and reach target (p=0.01). Paradoxically, patients who were current smokers demonstrated a beneficial effect on optimal TC control (29.2% vs 15.4%, p=0.027). In younger diabetic patients, risk factor modification at 1-year was poor despite identification of MVD. Developing an effective education and monitoring programme to improve glycaemic control in this high risk group should be a priority.
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