In Germany Diabetic Patients with Coronary Artery Disease are Treated More Intensively than Diabetic Patients with Other Manifestations of Atherothrombosis – Results from the REACH Registry

K. G. Parhofer; U. Zeymer; R. G. Stark; C. Binz; M. Schwertfeger; D. L. Bhatt; Ph. G. Steg; J. Röther; on behalf of the REACH Registry Investigators

doi:10.1055/s-0029-1225648

Experimental and Clinical Endocrinology & Diabetes, Table of Contents

Exp Clin Endocrinol Diabetes 2010; 118(1): 51-56
DOI: 10.1055/s-0029-1225648

Article

In Germany Diabetic Patients with Coronary Artery Disease are Treated More Intensively than Diabetic Patients with Other Manifestations of Atherothrombosis – Results from the REACH Registry

K. G. Parhofer¹ , U. Zeymer² , R. G. Stark³ , C. Binz⁴ , M. Schwertfeger⁵ , D. L. Bhatt⁶ , Ph. G. Steg⁷ , J. Röther⁸ , on behalf of the REACH Registry Investigators⁹

¹Department of Internal Medicine II, Grosshadern, Ludwig-Maximilians University, Munich, Germany
²Medical Department B, Klinikum Ludwigshafen, Ludwigshafen, Germany
³Institute for Health Economics and Health Care Management, Helmholtz-Zentrum, Munich, Germany
⁴Medical Department, Bristol-Myers Squibb GmbH & Co. KGaA, Munich, Germany
⁵Medical Affairs CVT, Sanofi-Aventis Deutschland GmbH, Berlin, Germany
⁶VA Boston Healthcare System and Brigham and Women's Hospital, Boston, USA
⁷INSERM U-698, Université Paris 7, Assistance Publique – Hôpitaux de Paris, Paris, France
⁸Department of Neurology, Johannes Wesling Klinikum, Minden, Germany
⁹A list of REACH investigators is posted on the REACH website (www.reachregistry.org)

Abstract

Introduction: Atherothrombosis can present as coronary artery disease (CAD) cerebrovascular disease (CVD) and peripheral arterial disease (PAD). It is unknown whether diabetics with CAD differ from those with other manifestations of atherothrombosis such as CVD or PAD regarding clinical characteristics, biochemical parameters, or medications.

Material and Methods: The REACH (REduction of Atherothrombosis for Continued Health) registry evaluated 67 888 patients with established atherothrombosis or risk factors. Of 5 646 recruited German patients, 2 381 (42%) are diabetic. Of these 1 438 (60%) have CAD (either only CAD or in combination with CVD and/or PAD – CAD group) and 520 (22%) have other manifestations of atherothrombosis (either CVD or PAD or both – other manifestation group) and 18% have only risk factors. Differences between diabetics with CAD and diabetics with other manifestations of atherothrombosis were evaluated with multivariate models (79% male, 69±9 years, BMI 29±5 kg/m²) (SAS9.1).

Results: After correcting for age, sex and BMI, CAD patients receive (OR; 95% CI) more aspirin (1.5; 1.2–1.9; p=0.0002), statins (3.1; 2.6–3.7), beta-blockers (4.0; 3.8–4.8), diuretics (1.4; 1.2–1.6), ACE-inhibitors/ARBs (1.4; 1.2–1.7) and nitrates (8.8; 6.7–11.7) and significantly less often metformin (0.75; 0.61–0.93; p=0.01) with no differences concerning other antidiabetics. This resulted in significantly (p<0.05) lower blood-pressure (CAD 142/81 mmHg, other manifestations 145/82 mmHg) and LDL-cholesterol levels (CAD 108±37 mg/dl, other manifestations 123±37 mg/dl). Therefore more CAD patients reach LDL and blood-pressure-goals (CAD 47%/33%; other manifestations 30%/24%, respectively). Only few patients (CAD 7.1%, other manifestations 4.1%) reach all treatment goals. Furthermore, less CAD patients than patients with other manifestations of atherothrombosis are current smokers (11% vs. 22%).

Discussion: These data indicate considerable treatment differences between diabetics with CAD and those with other manifestations of atherothrombosis such as CVD or PAD. CAD patients are treated more intensively and therefore reach lower lipid and blood-pressure values.

Key words

diabetes - atherosclerosis - treatment goals - LDL-cholesterol - blood pressure

Full Text

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Correspondence

K. G. ParhoferMD

Medical Department II – Grosshadern

University Munich

Marchioninistraße 15

81377 Munich

Germany

Phone: +49-89-7095-3010

Fax: +49-89-7095-8879

Email: Klaus.Parhofer@med.uni-muenchen.de