Perioperative Cardiovascular Events More Common in Diabetes

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In perioperative major adverse cardiovascular and cerebrovascular events such as acute myocardial infarction and stroke, diabetes is considered a risk factor.
In perioperative major adverse cardiovascular and cerebrovascular events such as acute myocardial infarction and stroke, diabetes is considered a risk factor.

Perioperative major adverse cardiovascular and cerebrovascular events (MACCEs) increase over time and are more common for people with diabetes mellitus than without, according to an analysis of data on over 10.5 million noncardiac surgeries published in Diabetes Care.

Study investigators analyzed data on individuals at least 45 years of age who underwent major noncardiac surgery in the United States between 2004 and 2013.

Data were taken from the National Inpatient Sample of the Healthcare Cost and Utilization Project (HCUP), a large administrative database of hospital admissions. The study's primary outcome was MACCEs (in-hospital all-cause death, ischemic stroke, or acute myocardial infarction).

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A total of 10,581,621 hospitalizations were included in the final study sample, 8,143,417 of which were for individuals without diabetes and 2,438,204 for those with diabetes. Among those with diabetes, 3.3% experienced perioperative MACCEs, compared with 2.8% in the non-diabetes group.

Although diabetes was not associated with increased MACCEs after multivariable adjustment, uncontrolled diabetes was linked to adjusted odds that did show an increase (1.41; 95% CI, 1.38–1.43). This suggests that for perioperative cardiac events, uncontrolled diabetes is an independent risk factor.

Study investigators conclude, “[to] our knowledge, this is the largest study to report on national trends in cardiovascular outcomes for patients with diabetes undergoing major noncardiac surgery. Our findings suggest that a substantial unmet need exists for strategies to reduce the risk of perioperative cardiovascular events among patients with [diabetes mellitus].”

Reference

Newman JD, Wilcox T, Smilowitz NR, Berger JS. Influence of diabetes on trends in perioperative cardiovascular events [published online April 4, 2018]. Diabetes Care. doi: 10.2337/dc17-2046

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