Secondary Prevention of Cardiovascular Disease in Patients with Type 2 Diabetes: International Insights from the TECOS Trial

Abstract

Background—Intensive risk factor modification significantly improves outcomes for patients with diabetes and cardiovascular disease (CVD). However, the degree to which secondary prevention treatment goals are achieved in international clinical practice is unknown.

Methods—Attainment of 5 secondary prevention parameters—aspirin use, lipid control (low-density lipoprotein cholesterol <70 mg/dL or statin therapy), blood pressure control (<140 mmHg systolic, <90 mmHg diastolic), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, and non-smoking status—was evaluated among 13,616 patients from 38 countries with diabetes and known CVD at entry into TECOS. Logistic regression was used to evaluate the association between individual and regional factors and secondary prevention achievement at baseline. Cox proportional hazards regression analysis was used to determine the association between baseline secondary prevention achievement and cardiovascular death, myocardial infarction, or stroke.

Results—Overall, 29.9% of patients with diabetes and CVD achieved all 5 secondary prevention parameters at baseline, although 71.8% achieved at least 4 parameters. North America had the highest proportion (41.2%), whereas Western Europe, Eastern Europe, and Latin America had proportions of approximately 25%. Individually, blood pressure control (57.9%) had the lowest overall attainment while non-smoking status had the highest (89%). Over a median 3.0 years of follow-up, a higher baseline secondary prevention score was associated with improved outcomes in a step-wise graded relationship (adjusted HR 0.60 [95% CI 0.47-0.77] for those patients achieving all 5 measures versus those achieving ≤2).

Conclusions—In an international trial population, significant opportunities exist to improve the quality of cardiovascular secondary prevention care among patients with diabetes and CVD, which in turn could lead to reduced risk of downstream cardiovascular events.

Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00790205