Investigating factors associated with the prevalence of IHD among uncontrolled diabetic patients

Abstract

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Monash University Malaysia Background Ischaemic Heart Disease (IHD) is the leading cause of death in Malaysia (1), and there is an increasing trend in mortality due to IHD from 15.2% in 2019 to 17.2% in 2020 (2). IHD is one of the NCDs, estimated to have an RM100.79 billion burden of disease cost (health burden resulting from disability and loss of healthy life years), equivalent to 7% of GDP (3). Diabetes mellitus (DM) is known to be one of the risk factors for IHD. Purpose This study aimed to investigate the risk factors associated with the prevalence of IHD in uncontrolled diabetic patients. Besides, these characteristics were also compared among the duration of uncontrolled DM (<10 years vs. ≥10 years) Materials and Methods A single-center, cross-sectional study was conducted in a cardio referral center using Electronic Medical Record from 1 January 2020 to 31 December 2020. Adult patients aged ≥ 18 years old with uncontrolled type 2 diabetes mellitus (defined as HbA1c ≥7%) had their medical records examined for IHD upon first contact with the Diabetes Mellitus Therapy Adherence Clinic (DMTAC) pharmacist. Results A total of 495 participants with uncontrolled diabetes were included in the final analysis. The mean age and HbA1c in the overall cohort were 52.2 (10.9) years and 10.5%, respectively, with 59.4% (n=294) of them having <10 years of underlying diabetes. The majority were obese (64.8%) and had underlying hypertension (78.4%) and hyperlipidemia (78.4%). The prevalence of ischemic heart disease (IHD) among the overall cohort was 19.0% (n=94). Patients with longer underlying diabetes (≥10 years) were significantly older [mean age 56.8 (8.4) vs. 49.0 (11.4), p=<0.001], drinks alcohol [12.0% vs. 6.0%; p=0.022], had underlying hypertension [86.6 vs. 72.8; p=<0.001] and more comorbidities [mean 1.7 (0.55) vs. 1.5 (0.65); p=<0.001] compared to those with <10 years respectively. Independent predictors of IHD events were age 40-49 [OR 5.1 (95% CI 1.1-23.3); p=0.038], 50-59 [OR 5.36 (1.2-23.7); p=0.027] and ≥60 [OR 7.1 (1.6-32.3); p=0.011], alcohol use [OR 2.4 (1.1-5.1); p=0.023], ≥10 years of uncontrolled diabetes [OR 2.0 (1.2-3.3); P=0.007], and underlying hypertension [OR 2.6 (1.2-5.8); p=0.016]. Conclusion IHD has an indirect impact on social and economic development due to the high burden of the disease cost. In our study, older age, alcohol use, prolonged uncontrolled diabetes, and underlying hypertension seem to be associated with the prevalence of IHD complications. With the understanding of the recent outlook on diabetes, health education for the targeted population may negate this complication.