Does pharmacologic treatment in patients with established coronary artery disease and diabetes fulfil guideline recommended targets? A report from the EUROASPIRE III cross-sectional study

Eur J Prev Cardiol. 2015 Jun;22(6):753-61. doi: 10.1177/2047487314529353. Epub 2014 Apr 1.

Abstract

Purpose: The aim was to investigate the use of cardioprotective drug therapies (aspirin or other antiplatelet agents, β-blockade, renin-angiotensin-aldosterone-system-blockade (RAAS-blockade) and statins) and treatment targets achieved in a large cohort of patients with established coronary artery disease and diabetes across Europe.

Methods and results: EUROASPIRE III is an observational cross-sectional study of stable coronary artery disease patients aged 18-80 years from 76 centres in 22 European countries conducted in 2006-2007. The glycaemic status (prevalent, incident or no diabetes), the guideline treatment targets achieved and the use of pharmacotherapies were assessed at one visit 6-36 months after the index event. Of all 6588 patients investigated (women 25%), 4295 (65%) had no diabetes, 752 (11%) had incident diabetes and 1541 (23%) had prevalent diabetes. All four drugs were used in 44% of the patients with no diabetes, 51% with incident diabetes and 50% with prevalent diabetes respectively. Individual prescriptions for patients with no, incident and prevalent diabetes were respectively: aspirin or other antiplatelet agents 91, 93, and 91%; β-blockers: 81, 84, and 79%; RAAS-blockers: 77, 76, and 68%; statins: 80, 80, and 79%. The proportion of patients with coronary artery disease and prevalent diabetes reaching the treatment targets were 20% for blood pressure, 53% for low density lipoprotein cholesterol (LDL-cholesterol) and 22% for haemoglobin A1c (HbA1c).

Conclusion: This European study demonstrates a low use of cardioprotective drug therapies among patients with a combination of coronary artery disease and diabetes, which will be contributing to the poor achievement of risk factor treatment targets for cardiovascular prevention.

Keywords: Cardiovascular disease; EUROASPIRE; diabetes mellitus; secondary prevention.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adrenergic beta-Antagonists / therapeutic use
  • Adult
  • Aged
  • Aged, 80 and over
  • Angiotensin II Type 1 Receptor Blockers / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Biomarkers / blood
  • Blood Glucose / drug effects
  • Blood Glucose / metabolism
  • Cardiovascular Agents / therapeutic use*
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / drug therapy*
  • Coronary Artery Disease / epidemiology
  • Cross-Sectional Studies
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / drug therapy*
  • Diabetes Mellitus / epidemiology
  • Europe / epidemiology
  • Female
  • Glycated Hemoglobin A / metabolism
  • Guideline Adherence
  • Health Care Surveys
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Hypoglycemic Agents / therapeutic use*
  • Incidence
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors / therapeutic use
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'*
  • Treatment Outcome
  • Young Adult

Substances

  • Adrenergic beta-Antagonists
  • Angiotensin II Type 1 Receptor Blockers
  • Angiotensin-Converting Enzyme Inhibitors
  • Biomarkers
  • Blood Glucose
  • Cardiovascular Agents
  • Glycated Hemoglobin A
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Hypoglycemic Agents
  • Platelet Aggregation Inhibitors
  • hemoglobin A1c protein, human