Most people with type 2 diabetes are at high risk of having a heart attack or stroke, a new Spanish study has revealed.
Dr Manel Mata-Cases, a GP for the Catalan Institute of Health in Sant Adrià de Besòs, said the findings, published in the European Journal of Preventive Cardiology, should lead to urgent priority being given to prevent heart attacks and stroke in these patients.
The cross-sectional study used the Information System for the Development of Research in Primary Care (SIDIAP) database, which includes 74% of the total population in Catalonia and contains anonymous, longitudinal patient information extracted from the electronic medical record system (e-CAP).
The study comprised 373,185 adults, aged 18 and over, who had been diagnosed with type 2 diabetes by 31 December 2016.
The average age of the participants was 70.1 years and 45.2% were female. Out of the total cohort, 72% had high blood pressure, 45% were obese, 60% had high serum cholesterol, and 14% were current smokers.
The study team calculated the likelihood of each participant having a fatal heart attack or stroke within 10 years using categories in the ESC guidelines on diabetes and cardiovascular disease: very high risk (above 10%), high risk (between 5% and 10%), and moderate risk (below 5%).
They calculated that 53.4% were at very high risk, with 55.5% of men and 50.7% of women falling into that category. They also found that 39.6% were classified as high risk, while 7% had moderate risk of dying from a heart attack or stroke within 10 years.
Dr Mata-Cases said: “The most striking result of our study was that the vast majority of patients (93%) had a high or very high risk of fatal events within a decade.
“Half of patients in the very high-risk group had no history of heart disease, meaning they would not be receiving medications to prevent heart attacks and strokes.”
Calling for action within primary care to prevent heart attacks and stroke in type 2 diabetes patients, he said because cardiovascular risk in the Catalonia region is traditionally lower than in central and northern Europe and the USA, the results should “generate concern”.
“These findings in a primary care setting should fuel the implementation of integrated care,” he said. “Healthy behaviours are the cornerstone of preventing cardiovascular disease and need to be combined with control of blood glucose, serum cholesterol, and blood pressure. GPs and nurses should agree treatment objectives with patients considering their characteristics and preferences.”
Cebrián-Cuenca AM, Mata-Cases M, Franch-Nadal J, et al. Half of patients with type 2 diabetes mellitus are at very high cardiovascular risk according to the ESC/EASD: data from a large Mediterranean population. Eur J Prev Cardiol 14 November 2020; doi:10.1093/eurjpc/zwaa073.
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