Clinical significance
- •The extent of implementation of guideline recommended therapy in type 2 diabetes patients and isolated cerebrovascular disease is unknown.
- •In a large US outpatient registry of type 2 diabetes patients, those with isolated cerebrovascular disease had lowest rates of secondary cardiovascular prevention goals attainment as compared to patients with cerebrovascular disease plus coronary artery disease or peripheral artery disease, or those with isolated coronary artery disease/peripheral artery disease.
ABSTRACT
Background
Although secondary cardiovascular prevention is a focus among patients with type 2
diabetes (T2D) and coronary artery disease (CAD) or peripheral artery disease (PAD),
the application of guideline recommended therapy in T2D patients and isolated cerebrovascular
disease (CeVD) remains unknown.
Methods
In a US outpatient registry, T2D patients with established cardiovascular disease
from 2014-2018 were categorized as: isolated CeVD, CeVD plus CAD or PAD, or isolated
CAD/PAD. In each group, we determined the proportion with optimal secondary prevention
(HbA1C< 8%, blood pressure [BP] <130/80 mmHg, use of antithrombotics, use of statins, non-smoking/cessation
counseling, and use of glucose-lowering medications with cardioprotective effects
[sodium-glucose cotransporter [SGLT]-2 inhibitors, glucagon-like peptide [GLP]-1 receptor
agonists, thiazolidinediones [TZDs]). Hierarchical Poisson regression was used to
estimate relative rate of achieving each target across groups, adjusted for age and
chronic kidney disease (where relevant).
Results
Our study included 72,7467 T2D outpatients with cardiovascular disease (isolated CeVD
[n=99,777], CeVD plus CAD/PAD [n=158,361], isolated CAD/PAD [n=469,329]). Compared
with isolated CAD/PAD patients, isolated CeVD patients more often had an HbA1C<8% (adjusted relative risk [aRR]: 1.10, 95% CI 1.08-1.11) but less often had a BP
≤130/80 mmHg (aRR: 0.93, 95% CI 0.92-0.94]) or were prescribed antithrombotics (0.84,
95% CI 0.83-0.85), statins (0.86, 95% CI 0.85-0.87), GLP-1 agonists (0.75, 95% CI
0.73-0.78), SGLT2 inhibitors (0.73, 95% CI 0.71-0.76), and TZDs (aRR 0.76, 95% CI
0.73-0.78).
Conclusion
Among T2D patients, those with isolated CeVD had the lowest rates of secondary cardiovascular
prevention goals attainment. More focus is needed on secondary prevention in patients
with CeVD.
Key Words
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