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Cardiovascular risk in patients with and without diabetes presenting with chronic coronary syndrome in 2004-2016
Esben Skov Jensen1, Kevin Kris Warnakula Olesen1, Christine Gyldenkerne1
1Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark.
Insights
Cardiovascular risk in diabetes patients with chronic coronary syndrome decreased by 30% from 2004-2016. While significant, this reduction was less pronounced than in non-diabetes patients during the same period.
Area of Science:
- Cardiology
- Diabetology
- Public Health
Background:
- Prior research indicated reduced cardiovascular event risk in new-onset diabetes patients without pre-existing cardiovascular disease.
- The impact of recent advancements on cardiovascular risk in patients with chronic coronary syndrome and diabetes remained unclear.
Purpose of the Study:
- To investigate changes in cardiovascular risk among patients diagnosed with both diabetes and chronic coronary syndrome between 2004 and 2016.
Main Methods:
- A cohort study included patients with coronary artery disease confirmed by angiography in Western Denmark (2004-2016).
- Patients were stratified by angiography year and followed for two years to assess major adverse cardiovascular events (MACE).
- Analyses compared MACE risk between diabetes and non-diabetes groups, adjusting for time trends.
Main Results:
- In 5931 diabetes patients, two-year MACE risk decreased from 8.4% (2004-2006) to 6.7% (2013-2016), a 30% relative reduction.
- In 23,540 non-diabetes patients, MACE risk decreased from 6.3% to 3.9% over the same intervals.
- The relative risk reduction for MACE was 30% in diabetes patients versus 43% in non-diabetes patients (2013-2016 vs 2004-2006).
Conclusions:
- Between 2004 and 2016, the relative risk of major adverse cardiovascular events (MACE) decreased by 30% in patients with diabetes and chronic coronary syndrome.
- Although cardiovascular risk improved in this group, the reduction was less substantial compared to patients without diabetes.
- These findings highlight the need for continued efforts to mitigate cardiovascular risk in diabetic populations with established coronary artery disease.
Background:
It was recently shown that new-onset diabetes patients without previous cardiovascular disease have experienced a markedly reduced risk of adverse cardiovascular events from 1996 to 2011. However, it remains unknown if similar improvements are present following the diagnosis of chronic coronary syndrome. The purpose of this study was to examine the change in cardiovascular risk among diabetes patients with chronic coronary syndrome from 2004 to 2016.
Methods:
We included patients with documentation of coronary artery disease by coronary angiography between 2004 and 2016 in Western Denmark. Patients were stratified by year of index coronary angiography (2004-2006, 2007-2009, 2010-2012, and 2013-2016) and followed for two years. The main outcome was major adverse cardiovascular events (MACE) defined as myocardial infarction, ischemic stroke, or death. Analyses were performed separately in patients with and without diabetes. We estimated two-year risk of each outcome and adjusted incidence rate ratios (aIRR) using patients examined in 2004-2006 as reference.
Results:
Among 5931 patients with diabetes, two-year MACE risks were 8.4% in 2004-2006, 8.5% in 2007-2009, and then decreased to 6.2% in 2010-2012 and 6.7% in 2013-2016 (2013-2016 vs 2004-2006: aIRR 0.70, 95% CI 0.53-0.93). In comparison, 23,540 patients without diabetes had event rates of 6.3%, 5.2%, 4.2%, and 3.9% for the study intervals (2013-2016 vs 2004-2006: aIRR 0.57, 95% CI 0.48-0.68).
Conclusions:
Between 2004 and 2016, the two-year relative risk of MACE decreased by 30% in patients with diabetes and chronic coronary syndrome, but slightly larger absolute and relative reductions were observed in patients without diabetes.
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