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Cardiovascular outcomes in patients with type 2 diabetes at very high risk
Session:
Posters (Sessão 3 - Écran 3) - Fatores de risco cardiovascular
Speaker:
Daniel Seabra De Carvalho
Congress:
CPC 2023
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.14 Risk Factors and Prevention - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Daniel Seabra; Tiago Taveira-Gomes; Cristina Gavina
Abstract
<p>Introduction: Patients with Type 2 diabetes (T2D) and target-organ damage (TOD) are considered as very high risk for cardiovascular (CV) events, thus equivalent to patients with established atherosclerotic CV disease (ASCVD). However, event rates of CV outcomes in these distinct populations are not described in the Portuguese population.</p> <p>Aim: Our aim was to determine the 1-year event rate of the composite of CV death, hospitalization for MI or hospitalization for ischemic stroke (MACE) in 2 cohorts: T2D patients in primary prevention with TOD and T2D with ASCVD. Secondary outcomes were of all-cause death, the individual components of the composite and hospitalization for amputation or limb revascularization. One year event rates are presented as events/100 patient-years. </p> <p>Methods: We analyzed a local database integrating primary and secondary care, screening all electronic health records of individuals with at least 1 primary care visit in the 3 years prior to the index date, 31/12/2021. A total of 27,540 adult patients with T2D were identified. Criteria for primary prevention (PP) with TOD was any one of: albumin/creatinine ratio (ACR) >=30 mg/g; eGFR < 60 ml/min/1.73 m2; left ventricular hypertrophy; retinopathy. All patients with established ASCVD were considered as secondary prevention. </p> <p>Results: The cohort of interest had 15,337 patients (55.7% of the T2D population) either PP with TOD or ASCVD. Overall, 41.9% had CKD stage 3-4, 53.3% aged > 75 years, and 25% were on aspirin. Those in PP with TOD accounted for 44.3% of the total cohort. Event rate for MACE in the eligible population meeting criteria of PP with TOD was 4.2% patient/years (PY) and 21.8% PY in those in secondary prevention. All-cause death was 2.8% PY for TOD and 7.1% for ASCVD. Hospitalization for amputation or limb revascularization was 0.5% PY for PP with TOD and 1.9% PY for secondary prevention.</p> <p>Conclusions: In the very-high risk diabetic population, those with established ASCVD had a very high 1-year MACE event rate, that was 5-fold that of patients with TOD without evidence of ASCVD. These results suggest that an extreme risk category might be useful to identify those with T2D and ASCVD who may benefit from more intensive preventive measures and follow-up. </p>
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