Standard risk factors stratify already high-risk diabetic patients

By Eleanor McDermid, Senior medwireNews Reporter

Cardiovascular disease (CVD) risk factors are associated with mortality even among patients with Type 2 diabetes who are already at high risk due to having high coronary artery calcified plaque (CAC), say researchers.

“Thus, in a class of patients – all of whom are presumed to be at high risk – there are individuals at even greater risk”, say study investigator Donald Bowden (Wake Forest School of Medicine, Winston-Salem, North Caroline, USA) and team.

The team studied data from 371 patients in the Diabetes Heart Study who had total CAC greater than 1000 mg, comparing baseline characteristics of 153 patients who had died during an average 8.2 years of follow-up and 218 who survived.

Higher levels of glycated haemoglobin were significantly associated with increased mortality risk after accounting for confounders. But so were measures of decreased kidney function (estimated glomerular filtration rate and urinary albumin to creatinine ratio) and a poorer lipid profile (higher total and low-density lipoprotein cholesterol levels).

Also, higher levels of the inflammatory marker C-reactive protein were significantly associated with an increased likelihood of mortality.

“Importantly, these results confirm that, even among this high-risk group, heterogeneity in known CVD risk factors and associations with adverse outcomes are still observed and support their ongoing consideration as useful tools for individual risk assessment”, writes the team in Diabetes Care.

Just one type of medication – cholesterol-lowering drugs – was significantly associated with mortality, with the absence of use raising the likelihood of mortality by 44%. Bowden and team say this highlights the “importance of widespread prescription of cholesterol-lowering medications among individuals with type 2 diabetes and existing high CVD risk”, but add that prescription rates of statins in previous studies of diabetic patients have been low.

“These data suggest that cholesterol-lowering medications may be used less than recommended and need to be more aggressively targeted as a critical modifiable risk factor”, they say.

Although patients were selected for the study on account of having high CAC, within this group higher CAC scores were still associated with mortality, as were higher calcified plaque scores in the carotid and abdominal aortic arteries, and a combined score for all measured arteries.

“Interestingly, the derived multibed score showed a particularly strong association with mortality, suggesting that consideration of vascular calcification as a more global phenomenon may more fully reflect the extent of subclinical disease and attendant risk”, say the researchers.

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