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Observational Study
. 2015 Sep;8(5):508-16.
doi: 10.1161/CIRCOUTCOMES.115.001717.

Who Must We Target Now to Minimize Future Cardiovascular Events and Total Mortality?: Lessons From the Surveillance, Prevention and Management of Diabetes Mellitus (SUPREME-DM) Cohort Study

Jay R Desai, Gabriela Vazquez-Benitez, Zhiyuan Xu, Emily B Schroeder, Andrew J Karter, John F Steiner, Gregory A Nichols, Kristi Reynolds, Stanley Xu, Katherine Newton, Ram D Pathak, Beth Waitzfelder, Jennifer Elston Lafata, Melissa G Butler, H Lester Kirchner, Abraham Thomas, Patrick J O'Connor; SUPREME-DM Study Group
Collaborators
Observational Study

Who Must We Target Now to Minimize Future Cardiovascular Events and Total Mortality?: Lessons From the Surveillance, Prevention and Management of Diabetes Mellitus (SUPREME-DM) Cohort Study

Jay R Desai et al. Circ Cardiovasc Qual Outcomes. 2015 Sep.

Abstract

Background: Examining trends in cardiovascular events and mortality in US health systems can guide the design of targeted clinical and public health strategies to reduce cardiovascular events and mortality rates.

Methods and results: We conducted an observational cohort study from 2005 to 2011 among 1.25 million diabetic subjects and 1.25 million nondiabetic subjects from 11 health systems that participate in the Surveillance, Prevention and Management of Diabetes Mellitus (SUPREME-DM) DataLink. Annual rates (per 1000 person-years) of myocardial infarction/acute coronary syndrome (International Classification of Diseases-Ninth Revision, 410.0–410.91, 411.1–411.8), stroke (International Classification of Diseases-Ninth Revision, 430–432.9, 433–434.9), heart failure (International Classification of Diseases-Ninth Revision, 428–428.9), and all-cause mortality were monitored by diabetes mellitus (DM) status, age, sex, race/ethnicity, and a prior cardiovascular history. We observed significant declines in cardiovascular events and mortality rates in subjects with and without DM. However, there was substantial variation by age, sex, race/ethnicity, and prior cardiovascular history. Mortality declined from 44.7 to 27.1 (P<0.0001) for those with DM and cardiovascular disease (CVD), from 11.2 to 10.9 (P=0.03) for those with DM only, and from 18.9 to 13.0 (P<0.0001) for those with CVD only. Yet, in the [almost equal to]85% of subjects with neither DM nor CVD, overall mortality (7.0 to 6.8; P=0.10) and stroke rates (1.6–1.6; P=0.77) did not decline and heart failure rates increased (0.9–1.15; P=0.0005).

Conclusions: To sustain improvements in myocardial infarction, stroke, heart failure, and mortality, health systems that have successfully focused on care improvement in high-risk adults with DM or CVD must broaden their improvement strategies to target lower risk adults who have not yet developed DM or CVD.

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Conflict of interest statement

Disclosures

The authors declare that they have no other relevant financial interests.

Figures

Figure 1
Figure 1. Rates of myocardial infarction/acute coronary syndrome, stroke, heart failure, and all-cause mortality from 2005 – 200 by diabetes among 2.5 million insured persons across 11 health care systems
Black square = diabetes; black triangle = no diabetes Annual rate of change (Poisson regression): † = p<0.0001
Figure 2
Figure 2. Rates of myocardial infarction/acute coronary syndrome, stroke, heart failure, and all-cause mortality from 2005 – 2011 among 2.5 million insured persons across 11 health care systems by diabetes status and prior cardiovascular history
Open diamond = Diabetes with prior cardiovascular history; Solid triangle = Diabetes with no prior cardiovascular history; Open circle = No diabetes with no prior cardiovascular history Annual rate of change (Poisson regression): ns non-significant; ‡ p<0.05; || p<0.01; † p<0.001
Figure 3
Figure 3. Racial and ethnic rates of myocardial infarction/acute coronary syndrome, stroke, heart failure, and all-cause mortality from 2005 – 2011 among 1.25 million insured persons with diabetes across 11 health care systems
Cross = Non-hispanic Black; solid triangle = Hispanic; Open diamond = Non-Hispanic White; Open circle = Non-Hispanic Asian Annual rate of change (Poisson regression): ns non-significant; ‡ p<0.05; || p<0.01; † p<0.001
See this image and copyright information in PMC

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