, Mustafa Kılıçkap 2
, Sadi Guleç 2
, Yüksel Altuntaş 3
, Kubilay Karşıdağ 4
, Ahmet Temizhan 5
, Özge Telci Çaklılı 6
, Kevser Burcu Tümerdem Çalık 7
, Miraç Vural Keskinler 1
, Sumathy Rangarajan 8
, Salim Yusuf 8
2Department of Cardiology, Faculty of Medicine, Ankara University, Ankara, Türkiye
3Department of Endocrinology and Metabolism, Faculty of Medicine, University of Health Sciences, İstanbul Şişli Hamidiye Etfal Health Training and Research Hospital, İstanbul, Türkiye
4Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, İstanbul University, İstanbul, Türkiye
5Clinic of Cardiology, University of Health Science, Ankara City Hospital, Ankara, Türkiye
6Department of Endocrinology and Metabolism, Kocaeli City Hospital, Kocaeli, Türkiye
7Department of Health Administration, Marmara University Faculty of Health Sciences, İstanbul, Türkiye
8Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
Abstract
Background: The risk of cardiovascular disease is correlated with the frequency and control of associated risk factors in diabetes mellitus and may vary according to country. We evaluated risk factors for cardiovascular disease, cardiovascular events, and the use of preventive medications in patients with diabetes mellitus using the Prospective Urban and Rural Epidemiological Türkiye cohort.
Methods: Patients with diabetes mellitus versus without diabetes mellitus were compared for risk factors, cardioprotective drugs (angiotensin-converting enzyme inhibitors or angiotensin-II receptor antagonists, statins, and antiplatelets), and cardiovascular events. The primary outcome was major cardiovascular events (composite of cardiovas-cular death, myocardial infarction, stroke, or heart failure).
Results: Among 4041 participants, 549 (13.6%) had diabetes mellitus. The mean age (54.8 ± 8.4 vs. 49.3 ± 9.0 years, P <.001) and proportion of women (65.4% vs. 59.9%, P =.014) were higher in diabetics compared with non-diabetics. Hypertension, history of coronary heart disease, and use of statin, antiplatelets, and angiotensin-converting enzyme inhibitors or angiotensin-II receptor antagonists were more common in diabetics; however, the use of these medications at baseline was lower than optimal even in patients with diabetes mellitus and concomitant coronary heart disease (statin 31.2%, antiplatelets 46.9%, and angiotensin-converting enzyme inhibitors or angiotensin-II receptor antagonists 54.7%). During 11.5 years of follow-up, major cardiovascular events occurred in 288 (7.1%) patients, and the risk was higher in diabetics [hazard ratio (95% confidence interval) 1.71 (1.30-2.24); P <.001]. The increase in the risk of future events was comparable for those with diabetes mellitus alone without cardiovascular disease [hazard ratio 1.62 (1.20-2.20)] versus those with cardiovascular disease alone without diabetes mellitus [hazard ratio 1.31 (0.83-2.07)] and was additive in those with both conditions [hazard ratio 2.79 (1.65-4.69)]. The risk of major coronary events (myocardial infarction, angina, percutaneous, or surgical coronary intervention) was also higher in diabetes mellitus [hazard ratio 1.64 (1.26-2.15); P <.001].
Conclusion: Patients with diabetes mellitus have a higher risk of major cardiovascular events, and the risk is comparable to that observed in those with cardiovascular disease but no diabetes mellitus. The use of preventive medicines for cardiovascular diseases is disturbingly low in diabetics.