Objective: To assess the impact of preventative therapies on the extent of coronary artery disease (CAD) in people with and without diabetes in a real-world setting.
Research Design and Methods: Patient-level linked coronary angiography and hospital separation data at a large Australian tertiary referral hospital between 2013 and 2019 were obtained and a random sample of patient charts reviewed for medication use (renin-angiotensin system (RAS) inhibitors, statins and antiplatelets). Indication for angiography and extent of CAD were based on the original classification by treating cardiologists, classified as no disease, mild, moderate or severe. Propensity scores were estimated and used to weight in the ordinal logistic regression models. Models were fitted to assess trends in CAD severity in people with and without diabetes with adjusted odds ratios (adjOR) reported.
Results: For 805 people identified in the coronary angiography database with medication use information available, 386(48%) were diagnosed with diabetes. Angiographic evidence of CAD was found in 297(71%) and 301(78%) of people without and with diabetes, respectively. People with diabetes were at an increased risk of more extensive CAD disease compared to people without diabetes (adjOR: 1.37 95% C.I. 1.00, 1.88). However, when adjusted for the use of RAS inhibitors, statins and antiplatelets there was no difference in the extent of CAD between people with and without diabetes (adjOR: 1.22 95% C.I. 0.87, 1.69).
Conclusions: These findings highlight the increased risk that people with diabetes have for more extensive CAD than people without diabetes. Our results also suggest that with the aggressive and appropriate use of traditional cardiovascular disease preventative therapies it may be possible to significantly reduce the excess CAD burden observed in people with diabetes.
K.V. Kiburg: None. A.I. MacIsaac: None. G.E. McCluskey: None. V. Sundararajan: None. R. MacIsaac: None.