Recurrence of cardiovascular events in patients with type 2 diabetes: epidemiology and risk factors.
OBJECTIVE
The purpose of this study was to assess incidence of and risk factors for recurrent cardiovascular disease (CVD) in type 2 diabetes.


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.
Giorda
Carlo B
CB
Metabolism and Diabetes Unit, Regione Piemonte, Chieri, Italy. giordaca@tin.it
Avogaro
Angelo
A
Maggini
Marina
M
Lombardo
Flavia
F
Mannucci
Edoardo
E
Turco
Salvatore
S
Alegiani
Stefania Spila
SS
Raschetti
Roberto
R
Velussi
Mario
M
Ferrannini
Ele
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents
PLoS Med. 2006 Oct;3(10):e400
17048978
J Am Coll Cardiol. 2007 May 1;49(17):1772-80
17466227
N Engl J Med. 2005 Dec 22;353(25):2643-53
16371630
Diabet Med. 1991 Jan;8(1):28-31
1826240
J Clin Endocrinol Metab. 2004 Jun;89(6):2852-8
15181068
Circulation. 1993 Dec;88(6):2548-55
8252666
Diabetes Care. 1998 Jan;21(1):69-75
9538972
BMJ. 2005 Apr 23;330(7497):960-2
15845982
Am Heart J. 2006 Sep;152(3):585-92
16923435
Diabetes Care. 2007 May;30(5):1241-7
17290034
Stroke. 2007 Apr;38(4):1154-60
17332448
J Intern Med. 1998 Dec;244(6):495-505
9893103
BMJ. 2000 Aug 12;321(7258):405-12
10938048
Clin Cardiol. 1998 Mar;21(3):184-90
9541762
Eur Heart J. 2000 Jul;21(13):1052-62
10843823
Circulation. 2002 Mar 5;105(9):1082-7
11877359
Diabetes Care. 1996 Apr;19(4):305-12
8729151
N Engl J Med. 1998 Jul 23;339(4):229-34
9673301
JAMA. 1996 Apr 10;275(14):1104-12
8601930
J Epidemiol Community Health. 2004 Aug;58(8):635-41
15252064
JAMA. 1988 Dec 16;260(23):3456-60
2974889
Lancet. 1994 Nov 19;344(8934):1383-9
7968073
Diabetes Care. 1985 Nov-Dec;8(6):562-7
4075941
Diabet Med. 2004 Jul;21(7):738-45
15209767