Prevalence of unrecognized diabetes and risk factor control among patients with coronary heart disease and prognosis thereof

Abstract

To evaluate the prevalence of unrecognized diabetes in patients with coronary heart disease, the control of the risk factors of CHD, and the long-term prognosis of these patients. The clinical data of CHD patients with complete data, including clinical characters, target organ damage, percentage of controlled risk factors, and clinical results during follow up in the DESIRE (Drug-Eluting Stent Impact on REvascularization) database were analyzed. 3763 patients after revascularization for coronary heart disease were registered in the DESIRE database, 3683 of which had complete data recorded. 721 of the 3683 patients (19.8%) had established diabetes at admission, 303 (10.2%) without history of diabetes had fast glucose higher than the diagnostic criteria of diabetes. Another 722 patients had impaired fast glucose (IFG). 47.4% of the 3683 CHD patients had impaired glucose metabolism. The prevalence rates of systolic blood pressure>or=140 mm Hg, low density lipoprotein cholesterol>or=2.6 mmol/L, and current smoker at admission were 46.2%, 59.4%, and 48.8% respectively, all significantly higher than those of the established diabetes patients and those without (P=0.05, 0.0001, and 0.0001 respectively). The prevalence of three vessel disease was 41.6%, similar to that of the established diabetic patients (45.7%), and significantly higher than that of those without diabetic (P=0.0001). The percentage of creatinine>132 mmo/L signifying impaired renal function was 8.7% in the patients with unrecognized diabetes, significantly higher than those of the other 3 groups (all P=0.0001). 80.6% patients were followed up for a mean time of 30.0+/-12.1 months. The mortality rate of the patients with unrecognized diabetes was 5.7%, significantly higher than those of the patients with established diabetes (4.3%), those with IFG (3.6%), and those without diabetes (2.3%, all P=0.01). The rate of major adverse cardiac and cerebral events of the patients with unrecognized diabetes was 13.9%, similar to that of patients with established diabetes (14.3%), and significantly higher than that of the patients without diabetes (10.0%, P=0.01). The prevalence rate of diabetes is high in the CHD patients, the diagnosis of one third of which is missed. The target organ damages are more common and the risk factors control is poor among these patients. The prognosis of unrecognized patients after revascularization is poor in comparison with other groups.