Predictors of cardiovascular complication in patients with diabetes mellitus: a 5-year follow-up study (CREDENCE II Study)

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 776-795-Cardiometabolic Risk & Vascular Biology
Clinical
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-780
Rinkoo Dalan*1, Robin Choo2, Michelle Jong1, Daniel Ek Kwang Chew1 and Melvin Khee Shing Leow3
1Tan Tock Seng Hospital, Singapore, Singapore, 2A Star, 3Singapore Institute for Clinical, Singapore, Singapore
Predictors of cardiovascular complication in patients with diabetes mellitus: a 5-year follow-up study (CREDENCE II Study).

Objectives: In a previous study we had seen that hs-CRP concentrations are significantly higher in Indians compared to the Chinese patients with diabetes mellitus (CREDENCE Study)(1). In this follow up study of the same cohort, we aimed to determine which factors were able to predict a cardiovascular endpoint (IHD -inclusive of coronary revascularization (PCI, CABG), stroke and peripheral vascular disease (PVD)) or mortality in the subsequent 5 years.

 Methods: We evaluated the electronic medical records of the entire cohort (N=246) of patients with diabetes recruited in the CREDENCE study and recorded occurrences of cardiovascular complications or mortality 5 years after initial recruitment. Correlation and logistic regression analysis were performed to determine which initial clinical/biochemical variables were predictive of subsequent cardiovascular complications using Stata 10.0 (Stata Corp, College Station, TX, USA). All statistical tests were conducted at 5% level of significance.

 Results: There were 75 patient events (30%) reported in the subsequent 5 years, of which 49 (20%) had IHD, 25(10%) had a cerebrovascular event, and 18(7%) had a peripheral amputation or bypass procedure done. The all cause mortality rate was 18 (7%). Independent logistic regression analysis showed that the Indians were at higher risk for IHD compared to the Chinese (OR=2.36 (CI=1.01-5.48)). HbA1c correlated with a subsequent risk of IHD (OR=1.49 (95%CI: 1.20-1.85)) and mortality (OR= 1.41(95% CI: 1.06-1.88). Age also correlated with a subsequent risk of IHD (OR=1.05 (95%CI: 1.01-1.09)) and mortality (OR= 1.06 (95% CI: 1.01-1.12). LDL-cholesterol was a statistically significant predictor of stroke (OR=1.91(95%CI:1.16-3.16)) and PVD (OR=1.88 (95%CI:1.12-3.16)). Hs-CRP, sex, systolic and diastolic blood pressure and BMI did not reach statistical significance in this analysis.

 Conclusion: HbA1c and LDL-cholesterol remain the most important traditional modifiable factors in the control of subsequent cardiovascular complications. Although in CREDENCE (1), Indians had higher hs-CRP and were subsequently seen to have a higher risk of IHD when compared to the Chinese, a statistically significant association was not seen between hs-CRP and cardiovascular outcomes.  This study may be under-powered to detect a statistically significant association or there maybe other factors contributing to the higher risk of IHD in Indians.

Reference

1. Dalan R, Jong M, Chan SP, Hawkins R, Choo R, Lim B, Tam ML, Leow MKS. High-sensitivity C-reactive protein concentrations among patients with and without diabetes in a multiethnic population of Singapore: CREDENCE Study. Diabetes Metab Syndr Obes. 2010 Jun 22;3:187-95.

1. Dalan R, Jong M, Chan SP, Hawkins R, Choo R, Lim B, Tam ML, Leow MKS. High-sensitivity C-reactive protein concentrations among patients with and without diabetes in a multiethnic population of Singapore: CREDENCE Study. Diabetes Metab Syndr Obes. 2010 Jun 22;3:187-95.

Nothing to Disclose: RD, RC, MJ, DEKC, MKSL

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: We would like to thank the Endocrine and Metabolic Society of Singapore (EMSS) for the research grant that funded the initial CREDENCE 1 Study.