Abstract 1702: Atherosclerotic Disease Location Modifies Control and Treatment of Cardiovascular Risk Factors in Patients With Type 2 Diabetes
Introduction: Current guidelines consider peripheral arterial disease (PAD) and cerebrovascular disease (CBVD) as coronary artery disease (CAD) equivalents and propose the same treatment goals for risk factor management for all three locations of atherosclerotic disease.
Hypothesis: We assessed the hypothesis that differences exist in the control and medication treatment intensity of cardiovascular disease risk factors in patients with type 2 diabetes depending on the location of atherosclerotic disease (CAD, CBVD and PAD).
Methods: Cross-sectional analysis including 44,893 patients with type 2 diabetes of whom 17,571 had incident atherosclerotic disease (54.2% male; age 69 ± 9 years, body mass index 28.5 ± 4.4 kg/m2). Endpoints included uncontrolled cardiovascular disease risk factors [systolic blood pressure (SBP) ≥140 mmHg; LDL-C ≥130 mg/dl; and A1c (HbA1c) ≥8%] and the intensity of medical management in patients with uncontrolled cardiovascular disease risk factors. Intensity of medication management was defined as the use of two or more classes of antihypertensive agents for hypertension, of one or more lipid-lowering agents for lipid management and of two or more oral agents or insulin for anti-hyperglycemic management. Multiple-adjusted odds ratios were calculated for CAD, CBVD, and PAD after adjusting for sex, age, body mass index, current smoking, and diabetes duration.
Results: About 66% of the patients had CAD, 17.7% CBVD, and 24.7% PAD. Approximately 61% of the patients had SBP≥140 mmHg, 45% had LDL-C≥130 mg/dl, and 27% had A1c levels ≥8.0%. Lipid control was best in subjects with CAD (OR 0.90, P < 0.01), while control of hyperglycemia was worst in patients with PAD (OR 1.68, P < 0.0001). Intensity of lipid-lowering therapy was highest in patients with CAD (OR 2.07, P < 0.0001). Overall, the risk factor receiving the lowest intensity of treatment, independent of atherosclerotic disease location, was hypertension.
Conclusions: In conclusion, in subjects with type 2 diabetes and atherosclerotic disease, control of modifiable cardiovascular disease risk factors and intensity of medication management is modified by the location of atherosclerosis.