Recurrence of Cardiovascular Events in Patients With Type 2 Diabetes

Epidemiology and risk factors

  1. Carlo B. Giorda, MD1,
  2. Angelo Avogaro, MD2,
  3. Marina Maggini, PHD3,
  4. Flavia Lombardo, PHD3,
  5. Edoardo Mannucci, MD4,
  6. Salvatore Turco, MD5,
  7. Stefania Spila Alegiani, MD4,
  8. Roberto Raschetti, MD4,
  9. Mario Velussi, MD6,
  10. Ele Ferrannini, MD7 and
  11. for the Diabetes and Informatics Study Group
  1. 1Metabolism and Diabetes Unit, Regione Piemonte, Chieri, Italy
  2. 2Division of Metabolic Diseases, University of Padua, Padua, Italy
  3. 3National Institute of Health, Rome, Italy
  4. 4University of Florence and Azienda Ospedaliera Careggi, Florence, Italy
  5. 5Federico II University, Naples, Italy
  6. 6Casa di Cura Pineta del Carso, Aurisina, Trieste, Italy
  7. 7Department of Internal Medicine and Consiglio Nazionale delle Ricerche Institute of Clinical Physiology, University of Pisa School of Medicine, Pisa, Italy
  1. Corresponding author: Carlo B. Giorda, giordaca{at}tin.it

Abstract

OBJECTIVE—The purpose of this study was to assess incidence of and risk factors for recurrent cardiovascular disease (CVD) in type 2 diabetes.

RESEARCH DESIGN AND METHODS—We estimated the incidence of recurrent cardiovascular events in type 2 diabetic patients, aged 40–97 years, followed by a network of diabetes clinics. The analysis was conducted separately for 2,788 patients with CVD at enrollment (cohort A) and for 844 patients developing the first episode during the observation period (cohort B).

RESULTS—During 4 years of follow-up, in cohort A the age-adjusted incidence of a recurrent event (per 1,000 person-years) was 72.7 (95% CI 58.3–87.1) in men and 32.5 (21.2–43.7) in women, whereas in cohort B it was 40.1 (17.4–62.9) in men and 22.4 (12.9–32.0) in women. After controls were included for potential predictors (familial CVD, obesity, smoking, diabetes duration, glycemic control, microvascular complications, geographic area, and antihypertensive and lipid-lowering treatment), male sex, older age, and insulin use were significant independent risk predictors (cohort A) and serum triglyceride levels ≥1.69 mmol/l emerged as the only metabolic (negative) prognostic factor (cohort B). In both cohorts, a prior CVD episode, especially myocardial infarction, was by far the strongest predictor of recurrent CVD.

CONCLUSIONS—Approximately 6% of unselected diabetic patients in secondary prevention develop recurrent major CVD every year. Those with long-standing previous CVD show a higher incidence of recurrence. Male sex, age, high triglyceride levels, and insulin use are additional predictors of recurrence.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 9 September 2008.

    Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted August 8, 2008.
    • Received June 5, 2008.
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  1. Published online before print September 9, 2008, doi: 10.2337/dc08-1013 Diabetes Care November 2008 vol. 31 no. 11 2154-2159
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