First cardiovascular event in patients with type 2 diabetes mellitus of a cardiovascular risk management program of a poor colombian population: a cohort study
Background: According to several studies in population of high-income countries (HIC), patients with Type 2 diabetes mellitus (DM) have a considerably higher risk of cardiovascular morbidity and mortality. However, it is not clear if the magnitude of this association can be widespread in other popul...
- Autores:
-
Miranda-Machado, Pablo
Salcedo-Mejía, Fernando
Paz Wilches, Justo
Fernandez-Mercado, Juan
De la Hoz-Restrepo, Fernando
Alvis-Guzmán, Nelson
- Tipo de recurso:
- Article of journal
- Fecha de publicación:
- 2018
- Institución:
- Corporación Universidad de la Costa
- Repositorio:
- REDICUC - Repositorio CUC
- Idioma:
- eng
- OAI Identifier:
- oai:repositorio.cuc.edu.co:11323/4696
- Acceso en línea:
- http://hdl.handle.net/11323/4696
https://repositorio.cuc.edu.co/
- Palabra clave:
- Cardiovascular outcomes
Diabetes
Poor population
Resultados cardiovasculares
Diabetes
Población pobre
- Rights
- openAccess
- License
- http://creativecommons.org/licenses/by-nc-sa/4.0/
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| dc.title.spa.fl_str_mv |
First cardiovascular event in patients with type 2 diabetes mellitus of a cardiovascular risk management program of a poor colombian population: a cohort study |
| dc.title.translated.spa.fl_str_mv |
Primer evento cardiovascular en pacientes con diabetes mellitus tipo 2 de un cardiovascular programa de gestión de riesgos de un pobre población colombiana: un estudio de cohorte. |
| title |
First cardiovascular event in patients with type 2 diabetes mellitus of a cardiovascular risk management program of a poor colombian population: a cohort study |
| spellingShingle |
First cardiovascular event in patients with type 2 diabetes mellitus of a cardiovascular risk management program of a poor colombian population: a cohort study Cardiovascular outcomes Diabetes Poor population Resultados cardiovasculares Diabetes Población pobre |
| title_short |
First cardiovascular event in patients with type 2 diabetes mellitus of a cardiovascular risk management program of a poor colombian population: a cohort study |
| title_full |
First cardiovascular event in patients with type 2 diabetes mellitus of a cardiovascular risk management program of a poor colombian population: a cohort study |
| title_fullStr |
First cardiovascular event in patients with type 2 diabetes mellitus of a cardiovascular risk management program of a poor colombian population: a cohort study |
| title_full_unstemmed |
First cardiovascular event in patients with type 2 diabetes mellitus of a cardiovascular risk management program of a poor colombian population: a cohort study |
| title_sort |
First cardiovascular event in patients with type 2 diabetes mellitus of a cardiovascular risk management program of a poor colombian population: a cohort study |
| dc.creator.fl_str_mv |
Miranda-Machado, Pablo Salcedo-Mejía, Fernando Paz Wilches, Justo Fernandez-Mercado, Juan De la Hoz-Restrepo, Fernando Alvis-Guzmán, Nelson |
| dc.contributor.author.spa.fl_str_mv |
Miranda-Machado, Pablo Salcedo-Mejía, Fernando Paz Wilches, Justo Fernandez-Mercado, Juan De la Hoz-Restrepo, Fernando Alvis-Guzmán, Nelson |
| dc.subject.spa.fl_str_mv |
Cardiovascular outcomes Diabetes Poor population Resultados cardiovasculares Diabetes Población pobre |
| topic |
Cardiovascular outcomes Diabetes Poor population Resultados cardiovasculares Diabetes Población pobre |
| description |
Background: According to several studies in population of high-income countries (HIC), patients with Type 2 diabetes mellitus (DM) have a considerably higher risk of cardiovascular morbidity and mortality. However, it is not clear if the magnitude of this association can be widespread in other populations. The objective of this study was to determine the independent association between Type 2 DM and first cardiovascular event in Colombian Caribbean poor population with no records of previous cardiovascular events reported. Methods: We retrospectively reviewed the individual records from the hospitalizations database of 64,668 patients of cardiovascular risk management program from July 2014 to December 2015. We used a propensity score matching cohort analysis for this study. The Kaplan–Meier curves were constructed for the cardiovascular events related endpoints and matched Cox-regression analysis to estimate associations of a history of Type 2 DM with cardiovascular outcomes during 1.5 years of follow-up. A formal sensitivity analysis using The Breslow-Day and Tarone Homogeneity tests was conducted. Results: Out of 56,351 patients with no previous cardiovascular events records, 19,368 (34.4%) patients were found to suffer Type 2 DM. Using propensity scores for Type 2 DM, we gathered a cohort of 18,449 pairs of patients with and without Type 2 DM who were balanced on 22 baseline characteristics. A first cardiovascular event occurred in 650 (3.5%) and 403 (2.1%) matched patients with and without Type 2 DM, respectively, during 1.5 years of followup. Type 2 DM was associated with first cardiovascular event (HR 1.69; 95% CI 1.43–2.00; p = 0.000), AMI (HR 1.79; 95% CI 1.45–2.20; p = 0.000) and stroke (HR 1.54; 95% CI 1.18–2.02; p = 0.001). Hazard ratios (95% CIs) for the association of Type 2 DM with all-cause mortality, cardiovascular mortality and all-cause hospitalization were 1.36 (1.21–1.53; p < 0.001), 1.52 (1.12–2.08; p 0.004), and 1.20 (1.21–1.53; p < 0.001), respectively. Conclusion: Type 2 DM resulted to be a significant independent risk factor for first cardiovascular event in Colombian Caribbean poor population with no previous records of cardiovascular events. |
| publishDate |
2018 |
| dc.date.issued.none.fl_str_mv |
2018-09-26 |
| dc.date.accessioned.none.fl_str_mv |
2019-05-24T14:25:12Z |
| dc.date.available.none.fl_str_mv |
2019-05-24T14:25:12Z |
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Artículo de revista |
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http://purl.org/coar/resource_type/c_2df8fbb1 |
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http://hdl.handle.net/11323/4696 |
| dc.identifier.instname.spa.fl_str_mv |
Corporación Universidad de la Costa |
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REDICUC - Repositorio CUC |
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eng |
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eng |
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https://doi.org/10.1186/s12872-018-0993-z |
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Reassessing coronary artery bypass surgery versus percutaneous coronary intervention in patients with type 2 diabetes mellitus: a brief updated analytical report (2015-2017). Diabetes Ther. 2018;9(5):2163–71 [cited 2018 Nov 5]. Available from: http:// link.springer.com/10.1007/s13300-018-0504-3. 5. Bundhun PK, Bhurtu A, Yuan J. Impact of type 2 diabetes mellitus on the long-term mortality in patients who were treated by coronary artery bypass surgery: A systematic review and meta-analysis. Medicine (Baltimore). 2017; 96(22):e7022 [cited 2018 Nov 5]. Available from: http://insights.ovid.com/ crossref?an=00005792-201706020-00031. 6. Global Report on Diabetes WHO Library Cataloguing-in-Publication Data. ISBN [Internet]. [cited 2017 Dec 13];978:92–4. Available from: https://www. who.int/diabetes/global-report/en/ . 7. OMS | Enfermedades no transmisibles. WHO [Internet]. 2017 [cited 2018 Feb 9]; Available from: http://www.who.int/mediacentre/factsheets/fs355/es/ 8. Frenk J, Lozano R, Bobadiñla JL. La transición epidemiológica en America Latina. [cited 2018 Feb 9]; Available from: http://repositorio.cepal.org/ bitstream/handle/11362/12808/NotaPobla60_es.pdf?sequence=1 9. Ramos E. Transición Epidemiológica en Colombia: De Las Enfermedades Infecciosas a las No Transmisibles [Internet]. Vol. 3, Revista Ciencias Biomédicas. 2012 [cited 2018 Feb 9]. Available from: http://revistas. unicartagena.edu.co/index.php/cienciasbiomedicas/article/view/1112/1022 10. Observatorio Nacional de Salud. Informe Técnico; Carga de enfermedades por Enfermedades Crónicas No Transmisibles y Discapacidad en Colombia. Bogotá, Colombia; 2015. Available from: https://www.ins.gov.co/Direcciones/ ONS/Resumenes%20Ejecutivos/ Resumen%20ejecutivo%20informe%205%20Carga%20de%20enfermedad.pdf 11. Becker A, Bos G, de Vegt F, Kostense PJ, Dekker JM, Nijpels G, et al. Cardiovascular events in type 2 diabetes: comparison with nondiabetic individuals without and with prior cardiovascular disease 10-year follow-up of the Hoorn Study. Eur Heart J. 2003;24(15):1406–13 [cited 2018 Feb 10]. Available from: https://academic.oup.com/eurheartj/article-lookup/doi/10. 1016/S0195-668X(03)00197-0. 12. Lanas F, Avezum A, Bautista LE, Diaz R, Luna M, Islam S, et al. Risk factors for acute myocardial infarction in Latin America: the INTERHEART Latin American study. Circulation. 2007;115(9):1067–74 [cited 2018 Mar 27]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17339564. 13. O’Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376(9735):112– 23 [cited 2018 Mar 27]. Available from: http://www.ncbi.nlm.nih.gov/ pubmed/20561675. 14. Harumi Higuchi Dos Santos M, Sharma A, Sun J-L, Pieper K, McMurray JJV, Holman RR, et al. International variation in outcomes among people with cardiovascular disease or cardiovascular risk factors and impaired glucose tolerance: insights from the NAVIGATOR Trial. J Am Heart Assoc. 2017;6(1):e003892 [cited 2018 Mar 27]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28087508. 15. D’Agostino RB. Propensity scores in cardiovascular research. Circulation. 2007;115(17):2340–3 [cited 2018 Feb 10]. Available from: http://www.ncbi. nlm.nih.gov/pubmed/17470708. 16. Ministerio de Salud y Protección Social. Análisis de Situación de Salud según regiones Colombia 2013 [Internet]. [cited 2018 Nov 5]. Available from: https://www.minsalud.gov.co/Documentos y Publicaciones/Análisis de situación de salud por regiones.pdf. 17. Qazi MU, Malik S. Diabetes and Cardiovascular Disease: Insights from the Framingham Heart Study. Glob Heart. 2013;8(1):43–8 [cited 2018 Feb 10]. Available from: https://www.sciencedirect.com/science/article/pii/ S2211816013000021. 18. Lanas F, Potthoff S, Mercadal E, Santibáñez C, Lanas A, Standen D. Riesgo individual y poblacional en infarto agudo del miocardio: Estudio INTERHEART Chile. Rev Med Chil. 2008;136(5):555–60 [cited 2018 Mar 28]. Available from: http://www.scielo.cl/scielo.php?script=sci_arttext&pid= S0034-98872008000500002&lng=en&nrm=iso&tlng=en. 19. Yusuf S, Rangarajan S, Teo K, Islam S, Li W, Liu L, et al. Cardiovascular Risk and Events in 17 Low-, Middle-, and High-Income Countries. N Engl J Med. 2014;371(9):818–27 [cited 2018 Mar 28]. Available from: http://www.ncbi. nlm.nih.gov/pubmed/25162888. 20. Green JB, Bethel MA, Armstrong PW, Buse JB, Engel SS, Garg J, et al. Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2015;373(3):232–42 [cited 2017 Dec 13]. Available from: http://www.nejm. org/doi/10.1056/NEJMoa1501352. 21. White WB, Cannon CP, Heller SR, Nissen SE, Bergenstal RM, Bakris GL, et al. Alogliptin after Acute Coronary Syndrome in Patients with Type 2 Diabetes. N Engl J Med. 2013;369(14):1327–35 [cited 2017 Dec 13]. Available from: http://www.nejm.org/doi/10.1056/NEJMoa1305889. 22. Scirica BM, Bhatt DL, Braunwald E, Steg PG, Davidson J, Hirshberg B, et al. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med. 2013;369(14):1317–26 [cited 2017 Dec 13]. Available from: http://www.nejm.org/doi/10.1056/NEJMoa1307684. 23. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HAW. 10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes. N Engl J Med. 2008;359(15):1577– 89 Available from: http://www.nejm.org/doi/abs/10.1056/NEJMoa0806470. 24. Gerstein H, Jaeschke R. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes mellitus. Dr. Hertzel Gerstein in an interview with Dr. Roman Jaeschke. Polish Arch Intern Med. 2016;126(10):803–5 [cited 2017 Dec 13]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27872459. 25. Uthman OA, Hartley L, Rees K, Taylor F, Ebrahim S, Clarke A. Multiple risk factor interventions for primary prevention of cardiovascular disease in low- and middle-income countries. In: Uthman OA, editor. Cochrane Database of Systematic Reviews. Chichester: John Wiley & Sons, Ltd; 2015. [cited 2017 Dec 14]. Available from: http://doi.wiley.com/10.1002/14651858.CD011163.pub2. 26. Díaz J, Achilli F, Figar S, Waisman G, Langlois E, Galarza C, et al. Prevención de eventos cardiovasculares en hipertensos mayores de 65 años bajo el cuidado de un programa de control. Estudio de cohorte. [Internet]. Vol. 22, Anales de Medicina Interna. Arán Ediciones, S.A; 2005 [cited 2017 Dec 14]. 17–21 p. Available from: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0212- 71992005000400003 27. Gagliardino JJ, Kleinebreil L, Colagiuri S, Flack J, Caporale JE, Siri F, et al. Comparison of clinical-metabolic monitoring and outcomes and coronary risk status in people with type 2 diabetes from Australia, France and Latin America. Diabetes Res Clin Pract. 2010;88(1):7–13 [cited 2018 Mar 28]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20153542. 28. Cuevas A, Arteaga A, Rigotti A. A Latin American Perspective on the New ACC/AHA Clinical Guidelines for Managing Atherosclerotic Cardiovascular Disease. [cited 2018 Feb 12]; Available from: http://svmi.web.ve/wh/ intertips/8.VISION-LATINOAMERICANA.pdf 29. Bethel MA, Green JB, Milton J, Tajar A, Engel SS, Califf RM, et al. Regional, age and sex differences in baseline characteristics of patients enrolled in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS). Diab Obes Metab. 2015;17(4):395–402 [cited 2018 Mar 28]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25600421. 30. Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015;373(22):2117–28 [cited 2018 Feb 12]. Available from: http://www.nejm.org/doi/10.1056/NEJMoa1504720. 31. Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JFE, Nauck MA, et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2016;375(4):311–22 [cited 2018 Feb 12]. Available from: http://www.nejm.org/doi/ 10.1056/NEJMoa1603827. 32. Erdmann E, Dormandy J, Wilcox R, Massi-Benedetti M, Charbonnel B. PROactive 07: pioglitazone in the treatment of type 2 diabetes: results of the PROactive study. Vasc Health Risk Manag. 2007;3(4):355 [cited 2018 Feb 12]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2291341/. 33. Kernan WN, Viscoli CM, Furie KL, Young LH, Inzucchi SE, Gorman M, et al. Pioglitazone after Ischemic Stroke or Transient Ischemic Attack. N Engl J Med. 2016;374(14):1321–31 [cited 2018 Feb 12]. Available from: http://www.nejm.org/doi/10.1056/NEJMoa1506930. 34. Dormandy JA, Charbonnel B, Eckland DJ, Erdmann E, Massi-Benedetti M, Moules IK, et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial. Lancet. 2005;366(9493):1279–89 [cited 2018 Feb 12]. Available from: http://www.thelancet.com/article/S0140-6736(05)67528-9/abstract. |
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Miranda-Machado, PabloSalcedo-Mejía, FernandoPaz Wilches, JustoFernandez-Mercado, JuanDe la Hoz-Restrepo, FernandoAlvis-Guzmán, Nelson2019-05-24T14:25:12Z2019-05-24T14:25:12Z2018-09-26http://hdl.handle.net/11323/4696Corporación Universidad de la CostaREDICUC - Repositorio CUChttps://repositorio.cuc.edu.co/Background: According to several studies in population of high-income countries (HIC), patients with Type 2 diabetes mellitus (DM) have a considerably higher risk of cardiovascular morbidity and mortality. However, it is not clear if the magnitude of this association can be widespread in other populations. The objective of this study was to determine the independent association between Type 2 DM and first cardiovascular event in Colombian Caribbean poor population with no records of previous cardiovascular events reported. Methods: We retrospectively reviewed the individual records from the hospitalizations database of 64,668 patients of cardiovascular risk management program from July 2014 to December 2015. We used a propensity score matching cohort analysis for this study. The Kaplan–Meier curves were constructed for the cardiovascular events related endpoints and matched Cox-regression analysis to estimate associations of a history of Type 2 DM with cardiovascular outcomes during 1.5 years of follow-up. A formal sensitivity analysis using The Breslow-Day and Tarone Homogeneity tests was conducted. Results: Out of 56,351 patients with no previous cardiovascular events records, 19,368 (34.4%) patients were found to suffer Type 2 DM. Using propensity scores for Type 2 DM, we gathered a cohort of 18,449 pairs of patients with and without Type 2 DM who were balanced on 22 baseline characteristics. A first cardiovascular event occurred in 650 (3.5%) and 403 (2.1%) matched patients with and without Type 2 DM, respectively, during 1.5 years of followup. Type 2 DM was associated with first cardiovascular event (HR 1.69; 95% CI 1.43–2.00; p = 0.000), AMI (HR 1.79; 95% CI 1.45–2.20; p = 0.000) and stroke (HR 1.54; 95% CI 1.18–2.02; p = 0.001). Hazard ratios (95% CIs) for the association of Type 2 DM with all-cause mortality, cardiovascular mortality and all-cause hospitalization were 1.36 (1.21–1.53; p < 0.001), 1.52 (1.12–2.08; p 0.004), and 1.20 (1.21–1.53; p < 0.001), respectively. Conclusion: Type 2 DM resulted to be a significant independent risk factor for first cardiovascular event in Colombian Caribbean poor population with no previous records of cardiovascular events.Antecedentes: Según varios estudios en poblaciones de países de altos ingresos (HIC), los pacientes con diabetes mellitus (DM) tipo 2 tienen un riesgo considerablemente mayor de morbilidad y mortalidad cardiovascular. Sin embargo, no está claro si la magnitud de esta asociación puede ser generalizada en otras poblaciones. El objetivo de este estudio fue determinar la asociación independiente entre la DM tipo 2 y el primer evento cardiovascular en la población pobre del Caribe colombiano, sin registros de eventos cardiovasculares anteriores. Métodos: Revisamos retrospectivamente los registros individuales de la base de datos de hospitalizaciones de 64,668 pacientes del programa de gestión de riesgo cardiovascular desde julio de 2014 hasta diciembre de 2015. Se utilizó un análisis de cohorte de puntuación de propensión que coincide con este estudio. Las curvas de Kaplan-Meier se construyeron para los puntos finales relacionados con eventos cardiovasculares y el análisis de regresión de Cox pareado para estimar las asociaciones de un historial de DM tipo 2 con resultados cardiovasculares durante 1,5 años de seguimiento. Se realizó un análisis formal de sensibilidad utilizando las pruebas de homogeneidad de Breslow-Day y Tarone. Resultados: de 56,351 pacientes sin registros de eventos cardiovasculares previos, se encontró que 19,368 pacientes (34.4%) sufrían DM tipo 2. Utilizando las puntuaciones de propensión para la DM tipo 2, reunimos una cohorte de 18,449 pares de pacientes con y sin DM tipo 2 que se equilibraron en 22 características de referencia. Se produjo un primer evento cardiovascular en 650 (3,5%) y 403 (2,1%) pacientes emparejados con y sin DM tipo 2, respectivamente, durante 1,5 años de seguimiento. La DM tipo 2 se asoció con el primer evento cardiovascular (HR 1.69; IC 95% 1.43–2.00; p = 0.000), IAM (HR 1.79; IC 95% 1.45–2.20; p = 0.000) e ictus (HR 1.54; IC 95% 1.18–2.02; p = 0.001). Los índices de riesgo (IC del 95%) para la asociación de la DM tipo 2 con la mortalidad por todas las causas, la mortalidad cardiovascular y la hospitalización por todas las causas fueron 1.36 (1.21–1.53; p <0.001), 1.52 (1.12–2.08; p 0.004), y 1.20 (1.21–1.53; p <0.001), respectivamente. Conclusión: La DM tipo 2 resultó ser un factor de riesgo independiente significativo para el primer evento cardiovascular en la población pobre del Caribe colombiano sin registros previos de eventos cardiovascularesMiranda-Machado, Pablo-1c412341-4919-4f7c-ad85-c0e8bbe76387-0Salcedo-Mejía, Fernando-e9ee3121-44d5-4f99-97c5-262c25bb46ff-0Paz Wilches, Justo-65a6bed1-0e54-4f20-ac89-3e5b4740c57c-0Fernandez-Mercado, Juan-afd25c85-8800-4cc3-8696-642fdb931deb-0De la Hoz-Restrepo, Fernando-e374ad59-e159-4dc6-906d-773d4be3e0b1-0Alvis-Guzmán, Nelson-588014d2-d3f0-41cd-a771-75436bddd378-0engBMC Cardiovascular Disordershttps://doi.org/10.1186/s12872-018-0993-z1. Ministerio de Salud y Protección Social. Carga de enfermedad por Enfermedades Crónicas No Transmisibles y Discapacidad en Colombia. 2015 [cited 2017 Dec 13]; Available from: https://www.minsalud.gov.co/sites/rid/ Lists/BibliotecaDigital/RIDE/IA/INS/informe-ons-5.pdf 2. Grundy SM, Benjamin IJ, Burke GL, Chait A, Eckel RH, Howard BV, et al. 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