Angina not associated with mortality in diabetes patients with coronary artery disease

Patients with type 2 diabetes and stable coronary artery disease (CAD) had similar risk of cardiovascular events and death, regardless of whether they had angina or angina-like symptoms, a study found.

Researchers performed a post hoc analysis in 2,364 patients with diabetes and CAD enrolled in the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial to determine the occurrence of death and a composite outcome of death, myocardial infarction and stroke during a five-year follow-up.

Results appeared in the Journal of the American College of Cardiology on Feb. 11.

There were 1,434 patients with angina, 506 with angina equivalents and 424 with neither condition. All patients received optimal medical therapy of lifestyle management and medication to maintain hemoglobin A1c levels less than 7%, low-density lipoprotein less than 100 mg/dL, and blood pressure of 130/80 mm Hg or less. The cumulative five-year death rates (total deaths, 316) were 12% in patients with angina, 14% in angina equivalents and 10% in neither (P=0.3), and composite cardiovascular outcome rates (total events, 548) were 24% in angina, 24% in angina equivalents and 21% in neither (P=0.5).

Compared to patients who had neither condition, the hazard ratios (HRs) for death, adjusted for confounders, were not different in the groups with angina (HR, 1.11; 99% CI, 0.81 to 1.53) and angina equivalents (HR, 1.17; 99% CI, 0.81 to 1.68). The same was true of cardiovascular events in patients with angina (HR, 1.17; 99% CI, 0.92 to 1.50) and angina equivalents (HR, 1.11; 99% CI, 0.84 to 1.48). Researchers noted that these findings suggest that these patients can be similarly managed in terms of risk stratification and preventive therapies.

An editorialist noted that given rising rates of diabetes and of health care costs, clinicians should carefully assess the risk, benefit and cost of widespread screening for CAD.

“Given the rapidly escalating epidemic of type 2 diabetes, the costs of widespread CAD screening of low-risk asymptomatic patients with diabetes would likely outweigh the minor clinical benefit,” stated the editorial. “For now, we should certainly optimize risk factor management for all patients with diabetes, and we will need more prospective cost-effectiveness studies to determine an optimal risk stratification strategy for patients with diabetes at risk for CAD.”