Secondary Prevention Lags For Patients With T2D and Cerebrovascular Disease

Patients with type 2 diabetes (T2D) and isolated cerebrovascular disease (CeVD) have the lowest rates of attaining secondary cardiovascular prevention goals, compared with patients with T2D and coronary artery disease (CAD) or peripheral artery disease (PAD) or CeVD plus CAD/PAD, according to a recent study published in The American Journal of Medicine.

With data from Veradigm Metabolic Registry (formerly the Diabetes Collaborative Registry), Justin B. Echouffo-Tcheugui, MD, PhD, et al., looked at 727,467 outpatients with T2D and cardiovascular disease from 2014 to 2018 to determine the use of guideline-recommended therapy in patients with T2D and isolated CeVD. Researchers divided the patients into three groups: isolated CeVD (n=99,777), CeVD plus CAD/PAD (n=158,361), and isolated CAD/PAD (n=469,329).

Results showed that patients with isolated CeVD, compared with those with isolated CAD/PAD, were more likely to have an hemoglobin A1c <8% (adjusted relative risk [aRR], 1.10), but they were less likely to have controlled BP ≤130/80 mm Hg (aRR, 0.93). They were also less likely to have been prescribed antithrombotics (aRR, 0.84), statins (aRR, 0.86), GLP-1 agonists (aRR, 0.75), SGLT2 inhibitors (aRR, 0.73) and TZDs (aRR, 0.76). This underuse of guideline-recommended secondary preventative therapies was not observed in patients who additionally had CAD/PAD.

Of note, being under the care of a cardiologist, compared with other specialties, was associated with a tendency for better goal attainment among patients with isolated CeVD.

Echouffo-Tcheugui, et al., conclude that more focus is required to provide appropriate secondary prevention strategies to patients with T2D and isolated cerebrovascular disease, emphasizing the need for collaboration among clinicians treating these cases. They state there is a pressing need for guideline and position statements to emphasize aggressive secondary prevention strategies for this population.

"Patients with cerebrovascular disease are at high risk for recurrent stroke as well as other ischemic/vascular events, and so aggressive secondary prevention efforts are imperative after cerebrovascular events," they state. "As ~30% of stroke patients have diabetes, there is tremendous opportunity for cross-specialty collaboration between neurologists and endocrinologists, who have not traditionally co-managed patients."

Clinical Topics: Dyslipidemia, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Nonstatins, Novel Agents, Statins

Keywords: National Cardiovascular Data Registries, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Secondary Prevention, Fibrinolytic Agents, Coronary Artery Disease, Glycated Hemoglobin A, Goals, Outpatients, Sodium-Glucose Transporter 2 Inhibitors, Cardiovascular Diseases, Cardiologists, Diabetes Mellitus, Type 2, Endocrinologists, Neurologists, Cerebrovascular Disorders, Peripheral Arterial Disease, Registries, Stroke, Glucagon-Like Peptide 1, Risk Factors

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