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

Pubmed ID: 33168394

Pubmed Central ID: PMC7870509

Journal: Journal of diabetes and its complications

Publication Date: March 1, 2021

Affiliation: University of California at Irvine, Heart Disease Prevention Program, Irvine, CA, USA; Department of Epidemiology, University of California Los Angeles, Los Angeles, CA, USA. Electronic address: ndwong@uci.edu.

MeSH Terms: Humans, Male, Female, Cardiovascular Diseases, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Risk Factors, Cohort Studies, Diabetes Complications, Risk Assessment, Diabetes Mellitus, Atherosclerosis, Lipoprotein(a), Heart Disease Risk Factors

Grants: U01 HL081616, U01 HL081649

Authors: Zhao Y, Wong ND, Xiang P, Coll B, López JAG

Cite As: Zhao Y, Xiang P, Coll B, López JAG, Wong ND. Diabetes associated residual atherosclerotic cardiovascular risk in statin-treated patients with prior atherosclerotic cardiovascular disease. J Diabetes Complications 2021 Mar;35(3):107767. Epub 2020 Oct 24.

Studies:

Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglyceride and Impact on Global Health Outcomes (AIM-HIGH)

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.