Expired CME Article

Control of Cardiovascular Risk Factors and Use of Aspirin in Diabetic Patients Remain Elusive

Authors: Rakesh Shrivastava, MD, Aameera Khan, MD, Vinodh Jeevanantham, MD, MPH, Amit Nautiyal, MD, Praveen Garg, MD, Pratap C. Reddy, MD

Abstract

Objectives: Type 2 diabetics are at higher risk for cardiovascular disease. To reduce this risk, the American Diabetes Association recommends traditional cardiovascular disease risk factor modification, reducing hemoglobin A1c (HbA1c), and the use of aspirin for patients over 30 years of age. The goal of this study was to analyze how well these goals were achieved in type 2 diabetics.


Methods: Patients with type 2 diabetes from July 2004 to June 2005 were included. Data were collected on demographics, preexisting coronary artery disease (CAD), blood pressure control, HbA1c, low-density lipoprotein cholesterol level, and microalbuminuria.


Results: One hundred thirty-nine patients were included (18% had CAD). Blood pressure was controlled in 46.04% of patients; 41.72% reached target HbA1c; 47.48% reached target low-density lipoprotein cholesterol; and 43.88% had microalbuminuria. No significant difference was noted between diabetics with or without CAD. Aspirin was used in 64% of patients with CAD and in 28.15% patients without CAD.


Conclusions: Optimal cardiovascular risk modification was achieved in less than 50% of type 2 diabetics. Aspirin remains underused for primary prevention. These results highlight the continued difficulties in achieving control of diabetes to the extent recommended by American Diabetes Association guidelines.


Key Points


* Cardiovascular risk factors are adequately controlled in less than 50% of type 2 diabetes mellitus patients.


* Aspirin remains underused for primary prevention of coronary artery disease in these patients.


* The gender gap in aspirin use for primary prevention of coronary artery disease is narrowing.


* The presence of a large number of risk factors for coronary artery disease was not associated with increased odds of using aspirin.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Standards of Medical Care in Diabetics—2006. American Diabetes Association. Diabetes Care 2006;29:S4–S42.
 
2. David KM, Richard BM. Comprehensive management of patients with type 2 diabetes: establishing priorities of care. Am J Manag Care 2001;7(suppl):S327–S343.
 
3. Cull CA, Neil HAW, Holman RR. Changing aspirin use in patients with type 2 diabetes in the UKPDS. Diabet Med 2004;21:1368–1371.
 
4. Klinke JA, Johnson JA, Guirguis LM, et al. Under use of aspirin in type 2 diabetes mellitus: prevalence and correlates of therapy in rural Canada. Clin Ther 2004;26:439–446.
 
5. Persell SD, Baker DW. Aspirin use among adults with diabetes: recent trends and emerging sex disparities. Arch Intern Med 2004;164:2492–2499.
 
6. McFarlane SI, Jacober SJ, Winer N, et al. Control of cardiovascular risk factors in patients with diabetes and hypertension at Urban Academic Medical Centers. Diabetes Care 2002;25:718–723.
 
7. Rolka DB, Fagot-Campagna N, Narayan KMV. Aspirin use among adults with diabetes. Estimates from the third National Health and Nutrition Examination survey. Diabetes Care 2001;24:197–201.
 
8. Montori VM, Bryant SC, O’Connor AM, et al. Decisional attributes of patients with diabetes: the aspirin choice. Diabetes Care 2003;26:2804–2809.