In a new study, researchers suggest that preventing heart attacks and strokes in type 2 diabetes patients managed in primary care should be an urgent priority.
They found that the vast majority of patients (93%) had a high or very high risk of fatal events within a decade.
Half of the patients in the very high-risk group had no history of heart disease, meaning they would not be receiving medications to prevent heart attacks and strokes.
The research was conducted by a team at the Catalan Institute of Health and elsewhere.
The study population consisted of 373,185 people aged 18 and over with a diagnosis of type 2 diabetes by 31 December 2016.
The average age was 70.1 years and 45.2% were female. Some 72% had high blood pressure, 45% were obese, 60% had high serum cholesterol, and 14% were current smokers.
The team calculated the likelihood of each participant having a fatal heart attack or stroke within 10 years.
The three categories are very high risk (above 10%), high risk (between 5% and 10%), and moderate risk (below 5%).
To be classified as very high risk, patients must have established cardiovascular disease (e.g. prior heart attack or stroke), or other conditions which threaten their health such as kidney impairment, or at least three cardiovascular risk factors (older age, high blood pressure, high serum cholesterol, smoking, obesity).
The team found over half of the participants (53.4%) were at a very high risk of fatal events.
This observation was more frequent in men (55.6%) than in women (50.7%). Some 39.6% were classified as high risk and just 7% had a moderate risk of dying from a heart attack or stroke within 10 years.
These findings in a primary care setting should fuel the implementation of integrated care.
Healthy behaviors are the cornerstone of preventing cardiovascular disease and need to be combined with control of blood glucose, serum cholesterol, and blood pressure.
GPs and nurses should agree on treatment objectives with patients considering their characteristics and preferences.”
Lifestyle advice for patients with diabetes
Quit smoking.
Reduce calorie intake to lower excessive body weight.
Adopt a Mediterranean diet supplemented with olive oil and/or nuts.
Avoid alcohol.
Do the moderate-to-vigorous physical activity for at least 150 minutes per week.
One author of the study is Dr. Manel Mata-Cases, a general practitioner for the Catalan Institute of Health.
The study is published in the European Journal of Preventive Cardiology.
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