CV Risk Factor Control in Patients with T2D and Coronary Artery Disease vs. Stroke

Stroke and coronary artery disease (CAD) share several cardiovascular (CV) risk factors (RFs) , including type 2 diabetes (T2D.) RF control is vital for secondary prevention of both conditions, but systems for care of patients (pts) after stroke or CAD events differ, and distinctions in care for these pts have not been examined. We compared RF control in pts with CAD vs. stroke at baseline in 3 recent large CV outcome trials (OTs) involving 11,622 T2D pts at high CV risk.We analyzed baseline data from (1) EMPA-REG OUTCOME (2) CAROLINA and (3) CARMELINA. RFs assessed included dyslipidemia, hypertension, smoking, and use of anti-platelet/-coagulant drugs. RF control was defined as (a) LDL-C <100 mg/dL or statin use; (b) SBP <140 + DBP <90 mmHg; (c) use of anti-platelet/-coagulant; and (d) not smoking. The quality of CV RF goal attainment was defined as the odds of having 3-4 vs. 0-2 RFs controlled. We calculated the odds ratio across macrovascular disease groups at baseline and by subgroups of age, sex and region in the trials, based on logistic regression.The odds ratios (ORs) (95% confidence intervals [CI]) for RF control in pts with CAD alone was higher than in those with stroke alone across all 3 trials: (1) 2.60 (95% CI 2.19-3.08) ; (2) 1.59 (1.18-2.15) , and (3) 2.20 (1.81-2.67) , respectively. The respective ORs (95% CIs) were lower (and rendered non-significant in CAROLINA) when RF control in pts with both CAD and stroke was compared to those with stroke alone: (1) 2.00 (1.52-2.64) , (2) 1.13 (0.72-1.79) and (3) 1.42 (1.08-1.86) . Results were consistent across all subgroups.We found significant disparities in CV RF control based on history of CAD and/or stroke in 3 contemporary T2D CVOTs, with less optimal control in stroke pts, particularly in those with stroke alone. The intermediate results in those with both CAD and stroke suggest a role for clinician factors. These findings require further study to understand their origins but emphasize the need for improved secondary prevention strategies in pts with stroke. Disclosure P.Balasubramanian: None. W.Kernan: None. K.N.Sheth: Research Support; American Heart Association, Becton, Dickinson and Company, Biogen, National Institutes of Health. A.Ofstad: Employee; Boehringer Ingelheim International GmbH. M.Mattheus: Employee; Boehringer Ingelheim Pharma GmbH & Co.KG. N.Marx: Consultant; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Genfit, Lilly, Merck Sharp & Dohme Corp., Novo Nordisk, Research Support; Boehringer Ingelheim International GmbH, Merck Sharp & Dohme Corp., Speaker's Bureau; Abbott, AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Bristol-Myers Squibb Company, Lilly, Novo Nordisk, Sanofi-Aventis Deutschland GmbH. S.E.Inzucchi: Advisory Panel; Abbott Diagnostics, ESPERION Therapeutics, Inc., vTv Therapeutics, Consultant; Merck & Co., Inc., Pfizer Inc., Other Relationship; AstraZeneca, Boehringer Ingelheim International GmbH, Lexicon Pharmaceuticals, Inc., Novo Nordisk.