Abstract

BackgroundAlthough it is known that patients with Type 2 Diabetes Mellitus (T2DM) are at an increased risk of coronary artery disease (CAD), the actual coronary artery burden of atherosclerotic disease in patients with and without T2DM in a real-world setting and its possible modification by preventative therapies has not been extensively documented.MethodsMerged coronary angiography and hospital discharge data between 2013 and 2019 were obtained for analysis and a random sub-sample of patient charts were reviewed for medication use. Propensity scores were estimated using logistic regression models and used to match patients, looking at the effect of severity of CAD over time in years in an ordinal logistic regression model. A separate propensity score was estimated and used to inverse probability weight the ordinal logistic regression looking at the effect of medication use on CAD severity in patients with and without T2DM.ResultsFrom 3,016 patients in the coronary angiography database, 1421 with T2DM and 1421 without T2DM were matched on propensity score. T2DM patients had more extensive CAD in 2018 compared to 2013 ((adjusted odds ratio) adjOR: 2.06 95% C.I. 1.38, 2.07), but this risk appeared to be attenuated in 2019. In contrast, there was no effect of time on CAD burden in patients without diabetes. In the sub-sample of 760 patients who underwent a chart review of their medication use, there were 367 (48%) with T2DM. For patients with T2DM 69.8% reported taking statins, 64.0% RAS inhibitors and 64.0% anti-platelet drugs. This was significantly higher than patients without diabetes of whom 46.6% reported taking statins, 49.0% RAS inhibitors and 49.9% anti-platelet drugs. As in the full matched sample, patients with diabetes had more extensive CAD (adjOR: 1.32 95% CI: 1.01, 1.74). However, after adjustment for the use of RAS inhibitors, statins and anticoagulants there was no difference in extent of CAD between patients with and without diabetes (adjOR: 1.14 95% CI: 0.85, 1.53).ConclusionsAlthough patients with diabetes have a greater extent of CAD in comparison to those without T2DM, preventative medication use decreases this CAD burden significantly.

Highlights

  • It is known that patients with Type 2 Diabetes Mellitus (T2DM) are at an increased risk of coronary artery disease (CAD), the actual coronary artery burden of atherosclerotic disease in patients with and without T2DM in a real-world setting and its possible modification by preventative therapies has not been extensively documented

  • We have evaluated the severity of CAD based on coronary angiogram for patients with and without T2DM admitted to a tertiary hospital in Australia over the seven-year period between 2013 and 2019

  • A random stratified sample of these patient charts were reviewed for medication use (renin-angiotensin system (RAS) inhibitors, Fig. 1 Flow chart of cohort numbers statins, anti-platelet drugs and medications related to diabetes management), with 50% of charts selected based on T2DM diagnosis (Fig. 1)

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Summary

Introduction

It is known that patients with Type 2 Diabetes Mellitus (T2DM) are at an increased risk of coronary artery disease (CAD), the actual coronary artery burden of atherosclerotic disease in patients with and without T2DM in a real-world setting and its possible modification by preventative therapies has not been extensively documented. Patients with diabetes are known to be at an increased risk for developing coronary artery disease (CAD) compared to patients with normoglycaemia. The extent of CAD involvement for patients with and without diabetes and the impact of traditional CV disease preventative therapies on disease within the coronary arteries, as assessed by angiography, has not been well characterised over the past 10 years. We hypothesis that people with diabetes will have a greater burden of atherosclerosis within their coronary arteries compared to those without diabetes, even following adjustment for the use of traditional CV protective medications

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