CHICAGO – The 5-year mortality of diabetes patients with stable angina is double that of stable angina patients without diabetes, according to a large, prospective, real-world, clinical practice registry.
Among 2,002 consecutive patients with stable angina and newly diagnosed, angiographically confirmed coronary artery disease enrolled in the German 50-center STAR Registry, 26% had diabetes. Their 5-year mortality rate was 29%, compared with the 15% rate in the nondiabetic patients, Dr. Anselm K. Gitt reported at the annual scientific sessions of the American Heart Association.
The patients with diabetes were on average older and had significantly higher rates of multivessel disease, impaired left ventricular function, and comorbid conditions than their counterparts without diabetes. But even after these factors were adjusted for in a multivariate Cox regression analysis, diabetes remained an independent predictor of mortality associated with a striking 1.8-fold increased risk, second only to the 2.5-fold risk conferred by a left ventricular ejection fraction of less than 40%, according to Dr. Gitt, senior staff physician at the Ludwigshafen (Germany) Heart Center.
Other independent predictors of 5-year mortality in STAR participants with stable angina were prior stroke, with a 1.5-fold increased risk; prior MI, with a 1.4-fold risk; age, which increased mortality risk by 7% per year; and female gender, which was associated with a significant 25% protective effect against mortality.
Patients in both groups had similar rates of statin, beta-blocker, aspirin, and antiotensin-converting enzyme inhibitor therapy. Those with diabetes had lower rates of percutaneous coronary intervention, but higher use of coronary artery bypass graft surgery.
Dr. Gitt declared having no relevant financial interests.