Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar;35(3):107767.
doi: 10.1016/j.jdiacomp.2020.107767. Epub 2020 Oct 24.

Diabetes associated residual atherosclerotic cardiovascular risk in statin-treated patients with prior atherosclerotic cardiovascular disease

Yanglu Zhao  1 , Pin Xiang  2 , Blai Coll  2 , J Antonio G López  2 , Nathan D Wong  3
Affiliations

Diabetes associated residual atherosclerotic cardiovascular risk in statin-treated patients with prior atherosclerotic cardiovascular disease

Yanglu Zhao et al. J Diabetes Complications. 2021 Mar.

Abstract

Aim: In statin-treated persons with atherosclerotic cardiovascular disease (ASCVD) the further ASCVD risk that diabetes mellitus (DM) adds is not well-quantified. We examined this residual risk for initial and total recurrent ASCVD events.

Methods: We studied 3271 patients with ASCVD on statin therapy in the AIM-HIGH clinical trial cohort. Cox regression and the Prentice, Williams, and Peterson model examined the excess risk of initial and total recurrent ASCVD events associated with DM over a 3- year mean follow-up. Predictors of first and total ASCVD events in those with and without DM were also examined.

Results: Of our cohort with ASCVD on statin therapy 40% also had DM. Those with vs. without DM were older, were less likely to be male or white. They had higher systolic blood pressure, lower HDL-C, LDL-C, lipoprotein (a), but higher triglycerides and BMI (all p < 0.01). Adjusted HRs were 1.21 (95% CI; 1.01-1.46, p = 0.038) and 1.23 (95% CI: 1.05-1.44, p = 0.012) for first and total recurrent ASCVD events, respectively. Homocysteine and lipoprotein(a) most strongly predicted events in those with and without DM, respectively.

Conclusion: In statin-treated patients with ASCVD, DM was associated with significantly greater residual risk over ASCVD alone for both first and total recurrent ASCVD events.

Keywords: Cardiovascular disease; Diabetes mellitus; Risk assessment; Statins.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest This study was supported by a contract from Amgen Pharmaceuticals to the University of California, Irvine. Dr. Wong reports research funding through the University of California, Irvine from Amgen, Amarin, and is on the speaker's bureau for Amarin and Sanofi. Drs. Xiang, Crespo, and Lopez are employees and stockholders of Amgen Inc.

Figures

Fig. 1.
Fig. 1.
First and total recurrent ASCVD event rates by DM status and sex. Males with DM had the highest event rates for first and total ASCVD events (64.5 and 85.3 per 1000 person-years, respectively); females with DM had ASCVD event rates comparable to those in non-DM males (50.4 vs 49.1 per 1000 person-years for first event and 54.6 vs 59.1 per 1000 person-years for total event).
Fig. 2.
Fig. 2.
Distribution of first and total recurrent ASCVD events by DM status. DM was an independent predictor of first and total ASCVD events, associated with a >20% excess of both first and total ASCVD events. The above HRs were adjusted for age, sex, white race, SBP, DBP, BMI, LDL-C, HDL-C, triglycerides, lp(a), smoking status, alcohol use, serum creatinine, homocysteine, history of CVD, hypertension medication and randomized treatment.
See this image and copyright information in PMC

Comment in

References

    1. Boulos N, Wong ND. Epidemiology of Diabetes and Cardiovascular Disease In: Wong ND, Malik S. Diabetes and Cardiovascular Disease: Evaluation, Prevention, and Management. Jaypee Brothers Medical Publishers, Ltd; New Delhi: 2015.
    1. Pasternak RC, Grundy SM, Levy D, Thompson PD. 27th Bethesda conference: matching the intensity of risk factor management with the hazard for coronary disease events, task force 3: spectrum of risk factors for coronary heart disease. J Am Coll Cardiol 1996;27:978–90. - PubMed
    1. Wong ND, Glovaci D, Wong K, Malik S, Franklin SS, Wygant G, et al. Global cardiovascular disease risk assessment in United States adults with diabetes. Diab Vasc Dis Res 2012;9:146–52. - PubMed
    1. Bulugahapitiya U, Siyambalapitiya S, Sithole J, Idris I. Is diabetes a coronary risk equivalent? Systematic review and meta-analysis. Diabet Med 2009;26:142–8. - PubMed
    1. Rana JS, Liu JY, Moffet HH, Jaffe M, Karter AJ. Diabetes and prior coronary heart disease are not necessarily risk equivalent for future coronary heart disease events. J Gen Intern Med 2016;31:387–93. - PMC - PubMed

Publication types

Substances