Impacto pronóstico de la localización de la enfermedad aterosclerosa previa en pacientes diabéticos. Estudio Barbanza-diabetes / Effect of the location of previous atherosclerotic disease on prognosis in diabetic patients. The Barbanza Diabetes Study

RESUMEN

Introducción y objetivos. Evaluar las diferencias pronósticas de las distintas formas de presentación de la enfermedad aterosclerosa en pacientes diabéticos. Métodos. Estudio multicéntrico de cohortes prospectivas, en el que participaron 31 médicos de atención primaria que registraron las características de 1.423 pacientes diabéticos que acudieron de forma consecutiva a sus consultas y fueron seguidos durante 45 ± 10 meses. Resultados. Pacientes (el 50%, varones) con media de edad de 66 años, el 64% hipertensos, el 70% dislipémicos y el 26% con eventos cardiovasculares previos. Tras el período de seguimiento, fallecieron 81 (6,2%) pacientes, 40 (3%) por causa cardiaca, y reingresaron 393 (30%), 179 (14%) por causa cardiovascular. En el análisis multivariable, resultaron determinantes independientes de mortalidad la edad (hazard ratio [HR] = 1,08; inter-valo de confianza [IC] del 95%, 1,05-1,11), tener enfermedad cardiovascular (HR = 2,15; IC del 95%, 1,12-4,14) y seguir tratamiento con diuréticos (HR = 3,40; IC del 95%, 1,76-6,56), mientras que la prescripción de inhibidores de la enzima de conversión de angiotensina y/o antagonistas de los receptores de angiotensina II resultó factor protector (HR = 0,48; IC del 95%, 0,25-0,93). En comparación con diabéticos sin evento cardiovascular previo, el riesgo de tener una complicación cardiovascular fue superior en los pacientes con antecedentes de cardiopatía isquémica (HR = 2,48; IC del 95%, 1,51-4,07), enfermedad cerebrovascular (HR = 2,51; IC del 95%, 1,28-4,92) y enfermedad vascular periférica (HR = 1,46; IC del 95%, 0,81-2,60). Conclusiones. El incremento del riesgo de complicaciones cardiovasculares es semejante entre los diabéticos con cardiopatía isquémica y con enfermedad cerebrovascular y más del doble respecto a diabéticos sin afección cardiovascular evidente (AU)

ABSTRACT

Introduction and objectives. To assess the effect of different forms of atherosclerotic disease on prognosis in diabetic patients. Methods. This multicenter prospective cohort study involved 1423 consecutive patients with diabetes mellitus who were recruited by 31 primary care physicians. The patients' characteristics were recorded and they were followed up for 45 (10) months. Results. The mean age of the patients (50% male) was 66 years, 64% had hypertension, 70% had dyslipidemia, and 26% had had a previous cardiovascular event. By the end of follow-up, 81 (6.2%) had died, 40 (3%) of whom due to cardiovascular causes, and 393 (30%) had been hospitalized, 179 (14%) of whom for cardiovascular disease. Multivariate analysis identified the following factors as independent predictors of mortality age (hazard ratio [HR]=1.08; 95% confidence interval [CI], 1.05-1.11), previous cardiovascular disease (HR=2.15; 95% CI, 1.12-4.14) and diuretic treatment (HR=3.40; 95% CI, 1.76-6.56), while the prescription of an angiotensin-converting enzyme inhibitor or an angiotensin-receptor antagonist had a protective effect (HR=0.48; 95% CI, 0.25-0.93). Compared with diabetics without a previous cardiovascular event, the risk of a cardiovascular event during follow-up was greater in those with a history of either ischemic heart disease (HR=2.48; 95% CI, 1.51-4.07), cerebrovascular disease (HR=2.51; 95% CI, 1.28-4.92), or peripheral vascular disease (HR=1.46; 95% CI, 0.81-2.60). Conclusions. The increase in the risk of a cardiovascular event was similar in diabetics with ischemic heart disease and those with cerebrovascular disease. In both cases, the risk was more than double that in patients without a history of cardiovascular disease (AU)