Exploring the relationship between coronary heart disease and type 2 diabetes: a cross-sectional study of secondary prevention among diabetes patients.

Bjørn Gjelsvik,Anne K Jenum,Geir Thue,Anh Thi Tran,John G Cooper,Ibrahimu Mdala,Sverre Sandberg,Karianne Fjeld Løvaas,Åsne Bakke,Tore J Berg,Tor Claudi,Kjersti Nøkleby

doi:10.3399/bjgpopen18x101636

Abstract

BackgroundCoronary heart disease (CHD) and stroke are the major causes of death among people with diabetes.AimTo describe the prevalence and onset of CHD and stroke among patients with type 2 diabetes mellitus (T2DM) in primary care in Norway, and explore the quality of secondary prevention.Design & settingA cross-sectional study of data was undertaken from electronic medical records (EMRs) of 10 255 patients with T2DM in general practice. The study took place in five counties of Norway (Oslo, Akershus, Rogaland, Hordaland, and Nordland). Quality of care was assessed based on national guideline recommendations.MethodSummary statistics with adjustments and binary logistic regression models were used.ResultsIn total, 2260 patients (22.1%) had CHD and 759 (7.4%) had stroke. South Asians had significantly more CHD than ethnic Norwegians (29.5%, 95% confidence interval [CI] = 26.1 to 33.0 versus 21.5%, CI = 20.6 to 22.3) and other ethnic groups, and experienced onset of CHD or stroke at a mean of 7 years before Norwegians. In 47.9% of the patients, CHD was diagnosed before T2DM. Treatment target for low-density lipoprotein (LDL) cholesterol was reached for 30.0% and for systolic blood pressure (SBP) for 65.1% of the patients with CHD. Further, 20.9% of patients with CHD were present smokers, and only 5.0% of patients reached all four treatment targets (no smoking, HbA1c ≤7.0%, SBP <135 mmHg, LDL-cholesterol <1.8 mmol/l).ConclusionThe diagnosis of CHD preceded the diagnosis of T2DM in half of the patients. The prevalence of CHD was highest and onset earlier among ethnic South Asians. More intensive treatment of lipids, blood pressure, and smoking are needed in patients with T2DM and CHD.

Highlights

Coronary heart disease (CHD) and stroke are the major causes of death among people with diabetes.[1]
Treatment target for low-density lipoprotein (LDL) cholesterol was reached for 30.0% and for systolic blood pressure (SBP) for 65.1% of the patients with CHD
The diagnosis of CHD preceded the diagnosis of type 2 diabetes mellitus (T2DM) in half of the patients

Summary

Introduction

CHD and stroke are the major causes of death among people with diabetes.[1]. T2DM has been associated with a doubling of the risk for CHD and stroke,[2] a somewhat lower risk has recently been reported in Scandinavia.[3,4] Cardiovascular disease (CVD) among patients with T2DM places pressure on the healthcare system,[5,6] but multifactorial secondary prevention reduces morbidity and years of life lost.[7,8,9]The influence of chronic hyperglycaemia on atherosclerosis is not fully understood,[10] and studies describing the relation between the onset of CVD and of T2DM are few. CHD and stroke are the major causes of death among people with diabetes.[1] T2DM has been associated with a doubling of the risk for CHD and stroke,[2] a somewhat lower risk has recently been reported in Scandinavia.[3,4] Cardiovascular disease (CVD) among patients with T2DM places pressure on the healthcare system,[5,6] but multifactorial secondary prevention reduces morbidity and years of life lost.[7,8,9]. There has, been an increasing awareness of diagnosing T2DM among patients with CHD. Statins have been shown to exert a diabetogenic effect,[11,12] which may contribute to an increasing prevalence of T2DM among patients with CHD. Coronary heart disease (CHD) and stroke are the major causes of death among people with diabetes

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