Abstract 3736: Glucose Lowering Treatment is Prognostically Important in Patients with Coronary Artery Disease and Newly Detected Diabetes Mellitus. A report from a Euro Heart Survey
Patients with coronary artery disease (CAD) and newly diagnosed diabetes mellitus (NDM) are at increased risk for cardiovascular events (CVE= death, myocardial infarction or stroke). This report from the Euro Heart Survey on Diabetes and the Heart relates glucose lowering (GL) treatment to cardiovascular prognosis.
Methods 3940 patients with CAD were enrolled at 110 centers in 25 countries, of whom 1425 (36%) had known DM and 2515 (64%) were glucometabolically characterized with an oral glucose tolerance test (WHO 1999) or fasting blood glucose (ADA 2004) and followed for one-year with respect to CVE.
Results 452 patients had NDM of whom 77 (17%) were started on pharmaceutical GL treatment (insulin 5%, oral glucose lowering drugs 94%, both 1%) while 375 (83%) not received any GL drugs. Baseline characteristics did not differ in patients receiving pharmaceutical GL treatment or not. None of the patients receiving pharmaceutical GL treatment died compared to 25 of those who did not (p=0.002). Myocardial infarction and stroke occurred in one vs. 13 and one vs. five patients respectively. Kaplan-Meier curves for CVE in patients receiving GL drugs (full) or not (empty) are shown in the figure⇓. Adjusting for age, sex, previous cardiovascular disease and use of evidence based medications in a Cox proportional hazard regression, patients on pharmaceutical GL treatment had a lower CVE hazard ratio during follow-up (HR 0.22, 95%CI 0.05–0.97; p=0.041) compared to those not on GL therapy.
Conclusion There was a striking decrease in event free survival in NDM patients prescribed pharmacological GL therapy following diagnosis underlining the importance to detect and treat such perturbations.