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
(hemoglobin [Hb]A1C <8%, blood pressure <130/80 mm Hg, 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 727,467 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% confidence interval [CI], 1.08-1.11)
but less often had a blood pressure of ≤130/80 mm Hg (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.
Keywords
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Article Info
Publication History
Published online: July 21, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: The Diabetes Collaborative Registry is funded by AstraZeneca (founding sponsor) and Boehringer Ingelheim. AstraZeneca has contributed scientific expertise to the design of the registry. The sponsors of the registry had no role in the final review and approval of the manuscript for submission.
Conflicts of Interest: Dr . James DeLemos reports fees for participation on Data Safety or Steering Committees for Novo Nordisc, Eli Lilli, Regeneron, Amgen Astra Zeneka and Verve Therapeutics. All other authors have no relationships relevant to the contents of this paper to disclose.
Authorship: The data are available from the authors upon request. JBE-T and SVA had access to the data, and all the authors had a role in writing the manuscript.
Identification
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© 2022 Elsevier Inc. All rights reserved.
