Cor Vasa 2004, 45(2):55-59

Differences between patients with and without diabetes in secondary-prevention intervention of the risk factors for coronary heart disease in the Czech Republic (EUROASPIRE II study)

Jakub Čech¹, Hana Rosolová^1,*, Otto Mayer jr.¹, Jaroslav Šimon¹, Markéta Plášková², Renata Cífková²

¹ II. interní klinika, Centrum preventivní kardiologie, Fakultní nemocnice a lékařská fakulta Univerzity Karlovy, Plzeň

² Pracoviště preventivní kardiologie, Institut klinické a experimentální medicíny, Praha, Česká republika

Aim:
To evaluate risk factor modification in patients with documented coronary heart disease (CHD) and with diabetes mellitus (DM), who were examined in Czech centers (i. e., in the Departments of Internal Medicine I and II of the University Hospital in Pilsen, and in the Department of Preventive Cardiology of the Prague-based Institute for Clinical and Experimental Medicine Center) participating in the EUROASPIRE II study, and to compare them with patients without DM.

Method:
Using standard protocol of the EUROASPIRE II study, a total of 410 patients including 300 patients without DM and 110 patients (27%) with DM were examined. Both groups were age- (mean age 59 years) and sex-matched.

Results:
Patients with CHD and DM were more obese (BMI > 30 kg/m2), with abdominal fat distribution in 60% compared with 35% of CHD patients without DM (p < 0.001). Goal blood pressure (BP) levels 130/85 mm Hg were not attained by 61% patients with DM while 35% of patients without DM did not reach a BP below 140/90 mm Hg (p < 0.001). Mild hypertension prevailed in the group of patients with DM (52%) compared with those patients without DM (28%), p < 0.001. Recommended total cholesterol and LDL-cholesterol levels were not attained by 63% and 67% of patients with and without DM, respectively (NS). Low HDL-cholesterol levels were noted in 65% and 35% of patients with and without DM, respectively (p < 0.05). The incidence of diabetic dyslipidemia was higher in patients with DM (12.7%) compared with those without DM (8%), p < 0.05. There was no difference in the use of statins, fibrates, beta-blockers, or acetylsalicylic acid in the secondary prevention of CHD between the groups of patients with and without DM. Cardiac patients with DM took statins and fibrates in only 38% and less than 30%, respectively. In cases of documented dyslipidemia, lipid-lowering therapy was provided to only 61% and 52% of patients with and without DM, respectively (NS). The proportion of patients with DM taking ACE inhibitors was 10% higher compared with those without DM.

Conclusion:
The level of risk factor intervention is unsatisfactory in either group of CHD patients. However, the situation is more alarming in patients with DM, i. e., those whose cardiovascular risk is still higher than the cardiovascular risk of patients without DM.

Keywords: Coronary heart disease; Diabetes mellitus; Secondary prevention

Published: February 1, 2004  Show citation