Screening for Glucose Perturbations and Risk Factor Management in Dysglycemic Patients With Coronary Artery Disease—A Persistent Challenge in Need of Substantial Improvement: A Report From ESC EORP EUROASPIRE V
Giulia Ferrannini, Dirk De Bacquer, Guy De Backer, Kornelia Kotseva, Linda Mellbin, David Wood, Lars Rydén, EUROASPIRE V collaborators, Chris P Gale, Branko Beleslin, Andrzej Budaj, Ovidiu Chioncel, Nikolaos Dagres, Nicolas Danchin, David Erlinge, Jonathan Emberson, Michael Glikson, Alastair Gray, Meral Kayıkçıoğlu, Aldo P. Maggioni, Klaudia Vivien Nagy, Aleksandr Nedoshivin, Anna-Sonia Petronio, Jolien W. Roos‐Hesselink, Lars Wallentin, Uwe Zeymer, Kornelia Kotseva, Guy De Backer, Ana Abreu, Carlos Aguíar, Jolita Badarienė, Jan Bruthans, Almudena Castro Conde, Renata Cífková, Jim Crowley, Kairat Davletov, Dirk De Bacquer, Delphine De Smedt, Johan De Sutter, Jaap W. Deckers, Mirza Dilić, Maryna Dolzhenko, H. Druais, Vilnis Dzērve, Andrejs Ērglis, Zlatko Fras, Dan Gaiță, Nina Gotcheva, Diederick E. Grobbee, Viveca Gyberg, Hosam Hasan Ali, Peter U. Heuschmann, Arno W. Hoes, Piotr Jankowski, Nebojša Lalić, Seppo Lehto, Dragan Lović, S. Mancas, Pedro Marques‐Vidal, Linda Mellbin, Davor Miličić, Erkin М Мirrakhimov, Oganov Rg, Nana Pogosova, Željko Reiner, Lars Rydén, Martin Stagmo, Stefan Störk, Jouko Sundvall, Lâle Tokgözoğlu, Costas Tsioufis, Duško Vulić, David Wood, Arno W. Hoes, Catriona Jennings, Agnieszka Adamska, S. Adamska, L.J. Tuomilehto, Oliver Schnell, Laura Råman, Anne‐Marie Willems, Michel De Pauw, Pieter Vervaet, Jessa Ziekenhuis, J. Bollen, E. Dekimpe, N. Mommen, G. Van Genechten, Paul Dendale, Audrey Bouvier, Patrick Chenu, D. Huyberechts, Alexandre Persu, Alden Begić, Azra Durak-Nalbantić, Alen Džubur, N. Hadzibegic, Amer Iglica, S. Kapidjic, A. Osmanagic Bico
Abstract
OBJECTIVE Dysglycemia, in this survey defined as impaired glucose tolerance (IGT) or type 2 diabetes, is common in patients with coronary artery disease (CAD) and associated with an unfavorable prognosis. This European survey investigated dysglycemia screening and risk factor management of patients with CAD in relation to standards of European guidelines for cardiovascular subjects. RESEARCH DESIGN AND METHODS The European Society of Cardiology’s European Observational Research Programme (ESC EORP) European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V (2016–2017) included 8,261 CAD patients, aged 18–80 years, from 27 countries. If the glycemic state was unknown, patients underwent an oral glucose tolerance test (OGTT) and measurement of glycated hemoglobin A1c. Lifestyle, risk factors, and pharmacological management were investigated. RESULTS A total of 2,452 patients (29.7%) had known diabetes. OGTT was performed in 4,440 patients with unknown glycemic state, of whom 41.1% were dysglycemic. Without the OGTT, 30% of patients with type 2 diabetes and 70% of those with IGT would not have been detected. The presence of dysglycemia almost doubled from that self-reported to the true proportion after screening. Only approximately one-third of all coronary patients had completely normal glucose metabolism. Of patients with known diabetes, 31% had been advised to attend a diabetes clinic, and only 24% attended. Only 58% of dysglycemic patients were prescribed all cardioprotective drugs, and use of sodium–glucose cotransporter 2 inhibitors (3%) or glucagon-like peptide 1 receptor agonists (1%) was small. CONCLUSIONS Urgent action is required for both screening and management of patients with CAD and dysglycemia, in the expectation of a substantial reduction in risk of further cardiovascular events and in complications of diabetes, as well as longer life expectancy.