Recurrence of Cardiovascular Events in Patients With Type 2 Diabetes

Recurrence of Cardiovascular Events in Patients With Type 2 Diabetes Epidemiology and risk factors Carlo B. Giorda , MD 1 , Angelo Avogaro , MD 2 , Marina Maggini , PHD 3 , Flavia Lombardo , PHD 3 , Edoardo Mannucci , MD 4 , Salvatore Turco , MD 5 , Stefania Spila Alegiani , MD 4 , Roberto Raschetti , MD 4 , Mario Velussi , MD 6 , Ele Ferrannini , MD 7 and for the Diabetes and Informatics Study Group 1 Metabolism and Diabetes Unit, Regione Piemonte, Chieri, Italy 2 Division of Metabolic Diseases, University of Padua, Padua, Italy 3 National Institute of Health, Rome, Italy 4 University of Florence and Azienda Ospedaliera Careggi, Florence, Italy 5 Federico II University, Naples, Italy 6 Casa di Cura Pineta del Carso, Aurisina, Trieste, Italy 7 Department of Internal Medicine and Consiglio Nazionale delle Ricerche Institute of Clinical Physiology, University of Pisa School of Medicine, Pisa, Italy Corresponding author: Carlo B. Giorda, giordaca{at}tin.it Abstract OBJECTIVE —The purpose of this study was to assess incidence of and risk factors for recurrent cardiovascular disease (CVD) in type 2 diabetes. RESEARCH DESIGN AND METHODS —We estimated the incidence of recurrent cardiovascular events in type 2 diabetic patients, aged 40–97 years, followed by a network of diabetes clinics. The analysis was conducted separately for 2,788 patients with CVD at enrollment (cohort A) and for 844 patients developing the first episode during the observation period (cohort B). RESULTS —During 4 years of follow-up, in cohort A the age-adjusted incidence of a recurrent event (per 1,000 person-years) was 72.7 (95% CI 58.3–87.1) in men and 32.5 (21.2–43.7) in women, whereas in cohort B it was 40.1 (17.4–62.9) in men and 22.4 (12.9–32.0) in women. After controls were included for potential predictors (familial CVD, obesity, smoking, diabetes duration, glycemic control, microvascular complications, geographic area, and antihypertensive and lipid-lowering treatment), male sex, older age, and insulin use were significant independent risk predictors (cohort A) and serum triglyceride levels ≥1.69 mmol/l emerged as the only metabolic (negative) prognostic factor (cohort B). In both cohorts, a prior CVD episode, especially myocardial infarction, was by far the strongest predictor of recurrent CVD. CONCLUSIONS —Approximately 6% of unselected diabetic patients in secondary prevention develop recurrent major CVD every year. Those with long-standing previous CVD show a higher incidence of