Mortality Risk Similar for Diabetes Patients With or Without Angina Symptoms

Patients with type 2 diabetes and stable coronary artery disease who were asymptomatic for angina at baseline had a similar high risk of all-cause mortality and major cardiovascular outcomes as patients who had angina or angina equivalent symptoms at baseline.

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These findings were published on Feb. 11 in a study in the Journal of the American College of Cardiology. The post-hoc analysis of 2,364 patients in the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial found that at five-year follow-up, the cumulative total death rate was 12 percent among the 1,434 patients with angina, 14 percent for the 506 patients with angina equivalents (dyspnea, fatigue or diaphoresis on exertion) and 10 percent for the 424 patients with neither of these symptoms (p = 0.3).

In addition, the cumulative five-year composite outcome rate was 24 percent in patients with angina, 24 percent in patients with angina equivalents and 21 percent in the asymptomatic patients. There also was no significant difference in the hazard ratio between the asymptomatic patients and the symptomatic patients in regard to all-cause mortality and the composite outcome.

Among the patients randomized to optimal medical therapy, there was no significant difference between the three groups of patients in terms of the five-year total death rate and the composite outcome. Similar results were found for the patients randomized to prompt revascularization.

Moving forward, the authors note that patients with type 2 diabetes and stable coronary artery disease should be managed similarly in regard to risk stratification and preventive therapies regardless of whether they are symptomatic or not for angina at presentation.

Keywords: Coronary Artery Disease, Diabetes Mellitus, Type 2, Coronary Disease, Dyspnea, Angioplasty, United States

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