Pre-Existing Cardiovascular Disease Largest Risk Factor for MACE in Patients With Type 2 Diabetes: Presented at EASD

By Jenny Powers

VIENNA, Austria -- September 22, 2014 -- Pre-existing cardiovascular disease (CVD) emerged as the greatest risk factor for experiencing a major acute cardiovascular event (MACE) among patients with type 2 diabetes, researchers said here at the 50th Annual Meeting of the European Association for the Study of Diabetes (EASD).

After controlling for baseline haemoglobin (Hb A1C) levels, male gender, longer duration of diabetes, prior or current macrovascular disease, cardiovascular medication use, and lack of physical active emerged as predictors for a MACE in patients starting insulin therapy.

Patients with a history of prior macrovascular disease showed the highest risk, with a hazard ratio (HR) of 2.88 (PP = .008) and the use of antiplatelet or anticoagulant medication at baseline (HR, 1.32; P = .044).

“Evidence of cardiovascular disease, either prior macrovascular disease or the use of antihypertensive, anticoagulant or antiplatelet medications at the beginning of type 2 diabetes therapy was strongly predictive of MACE,” said lead author Werner A. Scherbaum, MD, Heinrich-Heine University, University Hospital Düsseldorf, Düsseldorf, Germany.

“These factors may influence decisions on target individualisation in people starting insulin,” said lead author Werner A. Scherbaum MD, Heinrich-Heine University, University Hospital Düsseldorf, Düsseldorf, Germany.

The duration of diabetes was also associated with the risk of MACE (HR, 1.02; P = .011).

For the study, the researchers analysed data from the Cardiovascular Risk Evaluation in People With T2DM on Insulin Trial (CREDIT), which enrolled 2,999 individuals with type 2 diabetes. Over the 54-month course of the trial, 447 MACE were observed, including unstable angina (n = 21), heart failure (n = 78), non-fatal myocardial infarction (n = 44), myocardial revascularisation (n = 119), peripheral revascularisation (n = 46), non-fatal stroke (n = 57), and lower limb amputation (n = 22). Death due to CVD occurred in 60 patients.

Protective factors associated with a decreased risk for experiencing MACE were being physically active (HR, 0.73; P = .010) and being female (HR, 0.60: P

Funding for this study was provided by Sanofi.

[Presentation title: Cardiovascular Outcomes and Their Relationship to Risk Factors and Baseline Disease Over 4 Years When Starting Insulin in Type 2 Diabetes: The CREDIT Study. Abstract P940]

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