European Primary Care Cardiovascular Society

Screening and management of CAD patients with dysglycemia needs to be improved

Screening for Glucose Perturbations and Risk Factor Management in Dysglycemic Patients With Coronary Artery Diseased - A Persistent Challenge in Need of Substantial Improvement: A Report From ESC EORP EUROASPIRE V

Literature - Ferrannini G, de Bacquer D, De Backer G et al. - Diabetes Care 2020. https://doi.org/10.2337/dc19-2165

Introduction and methods

Morbidity and mortality in patients with coronary artery disease (CAD) is considerably higher in presence of dysglycemia, including type 2 diabetes and the preceding state of impaired glucose tolerance (IGT) [1-3]. Although guidelines recommend that CAD patients should be screened for glucose perturbations, in an estimated two-third of CAD patients T2DM and IGT is unrecognized [4,5].

For more than 20 years, the EUROASPIRE (European Action on Secondary and Primary Prevention by Intervention to Reduce Events) cross-sectional surveys have compared diagnostic and therapeutic strategies to standards of care recommended by guidelines [3,6-10]. The EUROASPIRE IV survey emphasized the need for improvement in glucose perturbation screening, in lifestyle and risk factor improvements and in pharmacological treatment of CAD patients [3,8].

The EUROASPIRE survey assessed the prevalence of known and newly detected dysglycemia and management in CAD patients. ESC EORP EAV is a cross-sectional study conducted in 2016–2017 in 131 centers across 27 countries within the ESC. Patients with a first or recurrent diagnosis of CAD or who received treatment of CABG, PCI, acute MI or acute myocardial ischemia were eligible and 8261 patients enrolled 6-24 months before the investigation. Median time between index event and interview for data collection was 1.1 year (IQR: 0.8-1.6). An oral glucose tolerance test (OGTT) was performed using 75 g glucose in 200 mL water in the morning after ≥10 h of fasting. Dysglycemia was defined as presence of T2DM or IGT according to the WHO, based on glucose levels measured with OGTT. Plasma glucose (PG) was analyzed in the fasting state (FPG) and 2 h after the glucose load (2hPG) with a point-of-care technique.

Main results

Conclusion

Screening for diabetes by OGTT of CAD patients in the ESC EORP EUROASPIRE V study showed that in a large portion of patients diabetes or IGT was unrecognized: presence of dysglycemia doubled from self-reported 29.7% to 58.8% following screening. In addition, pharmacological management and achievement of risk factor targets in CAD patients was poor and requires urgent action considering the substantial higher CV risk of cardiometabolic patients.

References

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