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Exp Clin Endocrinol Diabetes 2010; 118(1): 51-56
DOI: 10.1055/s-0029-1225648
Article

© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

In Germany Diabetic Patients with Coronary Artery Disease are Treated More Intensively than Diabetic Patients with Other Manifestations of Atherothrombosis – Results from the REACH Registry

K. G. Parhofer1 , U. Zeymer2 , R. G. Stark3 , C. Binz4 , M. Schwertfeger5 , D. L. Bhatt6 , Ph. G. Steg7 , J. Röther8 ,  on behalf of the REACH Registry Investigators9
  • 1Department of Internal Medicine II, Grosshadern, Ludwig-Maximilians University, Munich, Germany
  • 2Medical Department B, Klinikum Ludwigshafen, Ludwigshafen, Germany
  • 3Institute for Health Economics and Health Care Management, Helmholtz-Zentrum, Munich, Germany
  • 4Medical Department, Bristol-Myers Squibb GmbH & Co. KGaA, Munich, Germany
  • 5Medical Affairs CVT, Sanofi-Aventis Deutschland GmbH, Berlin, Germany
  • 6VA Boston Healthcare System and Brigham and Women's Hospital, Boston, USA
  • 7INSERM U-698, Université Paris 7, Assistance Publique – Hôpitaux de Paris, Paris, France
  • 8Department of Neurology, Johannes Wesling Klinikum, Minden, Germany
  • 9A list of REACH investigators is posted on the REACH website (www.reachregistry.org)
Further Information

Publication History

received 11.02.2009 first decision 06.05.2009

accepted 15.06.2009

Publication Date:
15 October 2009 (online)

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Abstract

Introduction: Atherothrombosis can present as coronary artery disease (CAD) cerebrovascular disease (CVD) and peripheral arterial disease (PAD). It is unknown whether diabetics with CAD differ from those with other manifestations of atherothrombosis such as CVD or PAD regarding clinical characteristics, biochemical parameters, or medications.

Material and Methods: The REACH (REduction of Atherothrombosis for Continued Health) registry evaluated 67 888 patients with established atherothrombosis or risk factors. Of 5 646 recruited German patients, 2 381 (42%) are diabetic. Of these 1 438 (60%) have CAD (either only CAD or in combination with CVD and/or PAD – CAD group) and 520 (22%) have other manifestations of atherothrombosis (either CVD or PAD or both – other manifestation group) and 18% have only risk factors. Differences between diabetics with CAD and diabetics with other manifestations of atherothrombosis were evaluated with multivariate models (79% male, 69±9 years, BMI 29±5 kg/m2) (SAS9.1).

Results: After correcting for age, sex and BMI, CAD patients receive (OR; 95% CI) more aspirin (1.5; 1.2–1.9; p=0.0002), statins (3.1; 2.6–3.7), beta-blockers (4.0; 3.8–4.8), diuretics (1.4; 1.2–1.6), ACE-inhibitors/ARBs (1.4; 1.2–1.7) and nitrates (8.8; 6.7–11.7) and significantly less often metformin (0.75; 0.61–0.93; p=0.01) with no differences concerning other antidiabetics. This resulted in significantly (p<0.05) lower blood-pressure (CAD 142/81 mmHg, other manifestations 145/82 mmHg) and LDL-cholesterol levels (CAD 108±37 mg/dl, other manifestations 123±37 mg/dl). Therefore more CAD patients reach LDL and blood-pressure-goals (CAD 47%/33%; other manifestations 30%/24%, respectively). Only few patients (CAD 7.1%, other manifestations 4.1%) reach all treatment goals. Furthermore, less CAD patients than patients with other manifestations of atherothrombosis are current smokers (11% vs. 22%).

Discussion: These data indicate considerable treatment differences between diabetics with CAD and those with other manifestations of atherothrombosis such as CVD or PAD. CAD patients are treated more intensively and therefore reach lower lipid and blood-pressure values.

Key words

diabetes - atherosclerosis - treatment goals - LDL-cholesterol - blood pressure

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Correspondence

K. G. ParhoferMD 

Medical Department II – Grosshadern

University Munich

Marchioninistraße 15

81377 Munich

Germany

Phone: +49-89-7095-3010

Fax: +49-89-7095-8879

Email: Klaus.Parhofer@med.uni-muenchen.de