Preventing heart attacks and strokes in type 2 diabetes patients managed in primary care should be an urgent priority, according to the study, ‘Half of patients with type 2 diabetes mellitus are at very high cardiovascular risk according to the 2019 ESC/EASD categories: data from a large Mediterranean population’, published on World Diabetes Day in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).
"The most striking result of our study was that the vast majority of patients (93%) had a high or very high risk of fatal events within a decade, said study author, Dr Manel Mata-Cases, a general practitioner for the Catalan Institute of Health in Sant Adrià de Besòs, Barceloa, Spain. “Half of patients in the very high-risk group had no history of heart disease, meaning they would not be receiving medications to prevent heart attacks and strokes,"
The cross-sectional study used the Information System for the Development of Research in Primary Care (SIDIAP) database, which includes 74% of the total population in Catalonia, Spain. The SIDIAP database contains anonymous, longitudinal patient information extracted from the electronic medical record system (e-CAP) used by all primary health providers in Catalonia.
The study population consisted of 373,185 people aged 18 and over with a diagnosis of type 2 diabetes by 31 December 2016. The average age was 70.1 years and 45.2% were female. Some 72% had high blood pressure, 45% had obesity, 60% had high serum cholesterol and 14% were current smokers.
The investigators calculated the likelihood of each participant having a fatal heart attack or stroke within ten years using categories in the 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%).
"As far as we know, this study in nearly 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 US; therefore, our results should generate concern and a call for action to prevent heart attacks and strokes in people with type 2 diabetes managed in primary care," he added.
To be classified as very high risk, patients must have established cardiovascular disease (e.g. prior heart attack or stroke), or other conditions which threaten their health such as kidney impairment, or at least three cardiovascular risk factors (older age, high blood pressure, high serum cholesterol, smoking, obesity).
Over half of the participants (53.4%) were at very high risk of fatal events. This observation was more frequent in men (55.6%) than in women (50.7%). Some 39.6% were classified as high risk and just 7% had moderate risk of dying from a heart attack or stroke within 10 years.
"These findings in a primary care setting should fuel the implementation of integrated care. Healthy behaviours are the cornerstone of preventing cardiovascular disease and need to be combined with control of blood glucose, serum cholesterol and blood pressure,” Mata-Cases concluded. “GPs and nurses should agree treatment objectives with patients considering their characteristics and preferences."