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DRUG TRENDS
SA JOURNAL OF DIABETES & VASCULAR DISEASE
14
VOLUME 18 NUMBER 1 • JULY 2021
CVD the leading cause of death in patients with type 2 diabetes
C
ardiovascular disease was the leading
cause of death among the over 16
000 patients with type 2 diabetes (T2DM)
who were enrolled in the SAVOR-TIMI 53
trial. Two-thirds (66.3%) of all 798 deaths
after a median 2.1 years of follow up were
caused by one of five cardiovascular (CV)
conditions, with sudden cardiac death
accounting for the largest share (30.1%) of
the total, Dr Ilaria Cavallari, and associates
at the University Campus Bio-Medico of
Rome, Italy said.
Most common among the non-CV causes
was malignancy at 13.9% of all deaths in
a T2DM population at high/very high risk
for CV disease
(n
= 16 492), followed by
infection (9.3%), the members of the TIMI
Study Group noted.
After variables independently associated
with overall mortality were identified, a
sub-distribution of competing risks was
constructed using a competing-risk analysis
based on the proportional hazards model,
they explained.
Prior heart failure was the clinical variable
most associated with CV death and could,
along with older age, worse glycaemic
control, prior CV events, peripheral artery
disease and kidney complications, ‘identify
a subgroup of T2DM patients at high risk
of mortality who are likely to achieve
the greatest benefit from aggressive
management of modifiable risk factors
and newer glucose-lowering agents,’ the
investigators wrote.
It was a pair of laboratory measurements,
however, that had the largest sub-
distribution hazard ratios. ‘Interestingly,
the magnitude of associations of abnormal
N-terminal pro-B-type natriuretic peptide
(sHR, 2.82) and high-sensitivity troponin T
(sHR, 2.46) measured in a stable population
were greater than clinical variables in the
prediction of all causes of death,’ Cavallari
and associates said.
Source: J Am Coll Cardiol 2021
Diabetes powerfully associated with CHD in women:
Women’s Health study
D
iabetes and insulin resistance, in addition
to hypertension, obesity and smoking,
appeared to be the strongest risk factors for
premature onset of coronary heart disease
(CHD), found an analysis from the large,
decades-long Women’s Health study.
While deaths related to heart disease have
declined among older people, studies suggest
that death rates among younger patients
have remained stagnant or increased slightly.
To understand what factors put younger
individuals at higher risk of premature CHD,
researchers from Brigham and Women’s
Hospital and the Mayo Clinic analysed more
than 50 risk factors in 28 024 women who
participated in the study.
Notably, women under 55 years with
type 2 diabetes had a 10-fold greater risk
of having CHD over the next two decades,
with lipoprotein insulin resistance (LPIR)
proving to be a strong, predictive biomarker
as well.
‘We’re going to see, unfortunately,
younger and younger people having heart
attacks,’ said corresponding author Dr Samia
Mora, of the Brigham’s Centre for Lipid
Metabolomics in the Division of Preventive
Medicine and an associate professor at
Harvard Medical School. ‘When a younger
individual has a cardiovascular event, it will
affect their quality of life going forward,
their productivity, and their contribution to
society.’
‘Prevention is better than cure, and many
risk factors for heart disease are preventable.
This study shows the impact that lifestyle
has on heart health in women of all ages,
and younger women in particular,’ said Dr
Sagar Dugani, a hospital internal medicine
practitioner at Mayo Clinic in Rochester,
Minnesota. Dugani is the co-first author of
the study.
The researchers analysed approximately
50 biomarkers associated with cardiovascular
health. Commonly used metrics such as
low-density lipoprotein (LDL) cholesterol (or
‘bad’ cholesterol) and haemoglobin A
1c
(a
measure of blood sugar levels) had much
weaker associations with CHD onset in
women younger than 55 years than LPIR, a
newer metric for insulin resistance. LPIR uses
a weighted combination of six lipoprotein
measures and is analysed through specialised
laboratory testing. Whereas LDL cholesterol
was only associated with a 40% increase
in risk of CHD onset in women under 55
years, LPIR demonstrated a six-fold (600%)
increase.
‘In otherwise healthy women, insulin
resistance, type 2 diabetes, and its sister
diagnosis, the metabolic syndrome, were
major contributors to premature coronary
events,’ said Mora. ‘Women under 55 who
have obesity had about a four-fold increased
risk for coronary events, as did women in that
age group who smoked or had hypertension.
Physical inactivity and family history are all
part of the picture as well.’
The researchers acknowledged the study
is limited in its generalisability – beyond its
focus on women, who have been shown
to have worse outcomes after premature
cardiac events than men – its participants
were over 95% white. According to Mora,
findings could be even more dramatic in
ethnic and racial groups that have a greater
prevalence of the metabolic syndrome,
insulin resistance and diabetes, among
other risk factors.
‘Diabetes is mostly preventable, but it’s
a systems-wide problem, and we urgently
need further research into new strategies
to address it,’ Mora said. ‘These could be
innovative lifestyle-based strategies, like
community efforts, greater public health
efforts, ways to medically target metabolic
pathways, or new surgical approaches.’
With the prevalence of diabetes and its
associated risk factors increasing dramatically,
and affecting more women than men,
the researchers emphasise the urgency of
developing effective interventions.
‘We need new strategies to improve
outcomes in these younger individuals and
address the risk of diabetes, because we’re
only seeing the beginning of this epidemic
now,’ said Mora.
Source: MedicalBrief 2021