Evidence-based medication and revascularization: powerful tools in the management of patients with diabetes and coronary artery disease: a report from the Euro Heart Survey on diabetes and the heart.
BACKGROUND
Patients with diabetes mellitus (DM) and coronary artery disease (CAD) have a poor prognosis. Underutilization and reduced efficacy of evidence-based medications (EBM) or revascularization are among suggested explanations. This report compares the impact of EBM and revascularization on mortality and cardiovascular events (CVE=mortality, myocardial infarction or stroke) in CAD patients with and without DM.


METHODS
Between February 2003 and January 2004 the Euro Heart Survey on Diabetes and the Heart recruited patients with CAD at 110 centers in 25 European countries. The patients were followed with respect to one-year CVE.


METHODS
The study population included a total of 3488 patients: 2063 (59%) in the non-DM and 1425 (41%) in the DM group. EBM was defined as the combined use of renin-angiotensin-aldosterone system inhibitors, beta blockers, antiplatelets and statins while revascularization comprised thrombolysis, percutaneous coronary intervention or coronary artery bypass grafting.


RESULTS
Of the eligible patients, 44% with DM and 43% of those without DM received EBM, while 34 and 40% were revascularized. In patients with DM both EBM (0.37, 95% confidence interval (CI), 0.20-0.67, P=0.001) and revascularization (0.72, 95% CI, 0.39-1.32, P=0.275) had an independent protective effect as regards one-year mortality and as regards CVE (0.61, 95% CI, 0.40-0.91, P=0.015 and 0.61, 95% CI, 0.39-0.95, P=0.025, respectively) in patients with DM compared with the impact of these two approaches in those without DM.


CONCLUSIONS
The systematic use of EBM and revascularization has a highly rewarding, favorable impact on one-year prognosis of DM patients with CAD.
Anselmino
Matteo
M
University Department of Cardiology, San Giovanni Battista-Molinette-Hospital, Turin, Italy.
Malmberg
Klas
K
Ohrvik
John
J
Rydén
Lars
L
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000628:therapy*; D003920:Diabetes Mellitus / Q000401:mortality / Q000628:therapy*; D005060:Europe / Q000453:epidemiology; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D009204:Myocardial Revascularization / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors