Abstract 19191: Retinopathy, Neuropathy, and Subsequent Cardiovascular Events in Patients With Type 2 Diabetes and Acute Coronary Syndrome: Analysis From Elixa and Importance of Duration of Diabetes
Introduction: Previous studies in patients with type 2 diabetes (T2DM) have shown an association between retinopathy (RET) and neuropathy (NEUR) and cardiovascular (CV) outcomes, although this relationship is less clear in those with prior CV events.
Hypothesis: RET and NEUR augment risk for subsequent CV events in people with T2DM and recent acute coronary syndrome (ACS).
Methods: ELIXA (NCT01147250, sponsored by Sanofi) enrolled 6068 patients (mean age 60±10; 69% men) with T2DM and recent ACS. Data on RET and NEUR history were self-reported at screening. Proportional hazards regression models were used to assess the association between RET and NEUR and CV events.
Results: At screening, RET and NEUR were reported in 10.7% and 16.7% of patients, respectively, and both in 5.5%. Patients who had RET and/or NEUR were older, had longer duration of T2DM, higher fasting glucose, HbA1c, and urine albumin to creatinine ratio, lower eGFR, and more frequently used insulin in comparison to those without RET or NEUR. In multivariate analysis, the most important predictor of either RET or NEUR was duration of T2DM. There was an association of RET and/or NEUR with primary endpoint composite (CV death, nonfatal myocardial infarction/stroke, hospitalization for unstable angina) (RET: HR=1.34 (1.09-1.65); NEUR: HR=1.20 (1.00-1.44)) and HF hospitalization (RET: HR=1.74 (1.24-2.45); NEUR: HR=1.44 (1.06-1.96)). RET, but not NEUR remained significant after adjustment for demographic and CV risk factors. However, all associations became nonsignificant after adjusting for duration of T2DM.
Conclusions: RET and NEUR are predictive of subsequent CV events in patients with T2DM and recent ACS. However, both of these associations can be accounted for by duration of T2DM.
Author Disclosures: J.P. Seferovic: None. R. Bentley-Lewis: Research Grant; Modest; Sanofi. B. Claggett: None. R. Diaz: Other Research Support; Modest; Sanofi. H.C. Gerstein: Other Research Support; Modest; Sanofi and Eli Lilly and Company. Consultant/Advisory Board; Modest; Sanofi; Novo Nordisk, Inc; Bristol-Myers Squibb Company; Roche Pharmaceuticals; AstraZeneca Pharmaceuticals LP; GlaxoSmithKline; BayerHealth Care; LLC;Merck, Boehringer IngelheimPharmaceuticals, Inc;. L.V. Køber: Other; Modest; Sanofi and Novartis Pharmaceuticals Corporation. F.C. Lawson: Employment; Modest; Sanofi. E.F. Lewis: Research Grant; Modest; Amgen, Inc; Novartis Pharmaceuticals Corporation; and Sanofi;. Consultant/Advisory Board; Modest; Sanofi; Novo Nordisk, Inc; Bristol-Myers Squibb Company; Roche Pharmaceuticals; AstraZeneca Pharmaceuticals LP; GlaxoSmithKline; BayerHealth Care; LLC;Merck, Boehringer IngelheimPharmaceuticals, Inc;. A.P. Maggioni: Other; Modest; Sanofi,OxfordUniversity, Eli Lilly and Company, and BMS. J.J. McMurray: Other; Modest; GlaxoSmithKline; PPD Development; LP; Merck; Oxford University; Amylin Pharmaceuticals, Inc; Eli Lilly and Company; Parexel; Bayer Health Care; LLC; Abbvie; and Sanofi. J.L. Probstfield: Other Research Support; Modest; Sanofi. Consultant/Advisory Board; Modest; Sanofi. M.C. Riddle: Other Research Support; Modest; AstraZeneca Pharmaceuticals LP, Eli Lilly, and Company, Sanofi, Novo Nordisk, Inc. Consultant/Advisory Board; Modest; Eli Lilly and Company, AstraZeneca Pharmaceuticals LP, Sanofi, Valeritas, LLC, and Elcelyx Therapeutics, Inc. Other; Modest; Sanofi. S.D. Solomon: Other Research Support; Modest; Abbott Laboratories, Inc; Amgen, Inc; Daiichi-Sankyo, Inc; Novartis Pharma AG; Theracos; Boston Scientific; NHLBI; Lone Star Heart; and Sanofi.. Consultant/Advisory Board; Modest; Novartis Pharma AG and Amgen, Inc;. J. Tardif: None. M.A. Pfeffer: Consultant/Advisory Board; Modest; Bayer, Genzyme, GlaxoSmithKline, Janssen, Lilly, Medicines Company, Merck, Novartis, Novo Nordisk, Relypsa, Salix, Sanofi, Thrasos and Vericel. Other; Modest; The Brigham and Women’s Hospital has patents for the use of inhibitors of the renin-angiotensin system in survivors of MI with Novartis, with licensing agreement is irrevocably transferred to charity. Research Grant; Significant; Amgen, Celladon, Novartis, Sanofi. Consultant/Advisory Board; Significant; Boehringer Ingelheim, DalCor, Teva.
- © 2016 by American Heart Association, Inc.