Patients with coronary artery disease and diabetes need improved management: a report from the EUROASPIRE IV survey: a registry from the EuroObservational Research Programme of the European Society of Cardiology

Abstract

BackgroundIn order to influence every day clinical practice professional organisations issue management guidelines. Cross-sectional surveys are used to evaluate the implementation of such guidelines. The present survey investigated screening for glucose perturbations in people with coronary artery disease and compared patients with known and newly detected type 2 diabetes with those without diabetes in terms of their life-style and pharmacological risk factor management in relation to contemporary European guidelines.MethodsA total of 6187 patients (18–80 years) with coronary artery disease and known glycaemic status based on a self reported history of diabetes (previously known diabetes) or the results of an oral glucose tolerance test and HbA1c (no diabetes or newly diagnosed diabetes) were investigated in EUROASPIRE IV including patients in 24 European countries 2012–2013. The patients were interviewed and investigated in order to enable a comparison between their actual risk factor control with that recommended in current European management guidelines and the outcome in previously conducted surveys.ResultsA total of 2846 (46 %) patients had no diabetes, 1158 (19 %) newly diagnosed diabetes and 2183 (35 %) previously known diabetes. The combined use of all four cardioprotective drugs in these groups was 53, 55 and 60 %, respectively. A blood pressure target of <140/90 mmHg was achieved in 68, 61, 54 % and a LDL-cholesterol target of <1.8 mmol/L in 16, 18 and 28 %. Patients with newly diagnosed and previously known diabetes reached an HbA1c <7.0 % (53 mmol/mol) in 95 and 53 % and 11 % of those with previously known diabetes had an HbA1c >9.0 % (>75 mmol/mol). Of the patients with diabetes 69 % reported on low physical activity. The proportion of patients participating in cardiac rehabilitation programmes was low (≈40 %) and only 27 % of those with diabetes had attended diabetes schools. Compared with data from previous surveys the use of cardioprotective drugs had increased and more patients were achieving the risk factor treatment targets.ConclusionsDespite advances in patient management there is further potential to improve both the detection and management of patients with diabetes and coronary artery disease.

The prevalence of type 2 diabetes mellitus in the adult population of Russia (NATION study)

“…По дан-ным исследования NATION, наиболее высокая частота развития СД2 отмечалась у людей в возрасте 65-69 лет, что соответствует недавно представленным в США дан-ным, где распространенность СД2 среди людей ≥65 лет составляет 24,7% [11]. Полученные сведения важны, так как в этой возрастной группе наблюдается высокая распространенность заболеваний сердечно-сосудистой системы, терапия которых становится более сложной при наличии сопутствующего СД [12,13]. Хотя распростра-ненность СД2 увеличивалась с возрастом, у людей в воз-расте ≥70 лет такой тенденции не отмечено.…”

Prevalence of diabetes in the adult population of Novosibirsk

“…По данным исследования NATION, также наиболее высокая частота СД2 отмечалась у людей в возрасте 65-69 лет -13,6%. Как справедливо от-мечают авторы исследования NATION, полученные сведе-ния важны, так как в этой возрастной группе наблюдается высокая распространенность заболеваний сердечно-сосу-дистой системы, терапия которых становится более слож-ной при наличии сопутствующего СД [13][14][15][16].…”

Cardiovascular Lipid Risk Factors and Rate of Cardiovascular Events After Myocardial Revascularization

“…11,[14][15][16] It seems that non-HDL would be a better predictor than LDLc of unstable atherosclerotic plaque. 17 Reiner et al reported that 12.2% of coronary patients in whom the LDLc target value was reached had pathological levels of non-HDL-c. In our sample, only 7.33% patients had non-HDL-c levels > 110 mg/dL and LDL-c < 80 mg/dL after myocardial revascularization.…”