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.
BACKGROUND
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.


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/m (2)) (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%).


CONCLUSIONS
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.
Parhofer
K G
KG
Department of Internal Medicine II, Grosshadern, Ludwig-Maximilians University, Munich, Germany. Klaus.Parhofer@med.uni-muenchen.de
Zeymer
U
U
Stark
R G
RG
Binz
C
C
Schwertfeger
M
M
Bhatt
D L
DL
Steg
Ph G
PG
Röther
J
J
D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D002561:Cerebrovascular Disorders / Q000097:blood / Q000188:drug therapy; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects; D003324:Coronary Artery Disease / Q000097:blood / Q000188:drug therapy*; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy*; D003925:Diabetic Angiopathies / Q000097:blood / Q000188:drug therapy*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D016491:Peripheral Vascular Diseases / Q000097:blood / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D012042:Registries; D012307:Risk Factors; D012907:Smoking; D013927:Thrombosis / Q000097:blood / Q000145:classification / Q000188:drug therapy*
D008078:Cholesterol, LDL