Prevalence and Management of Cardiovascular disease in a Diabetic-Renal cohort
M Jayapaul1, R Messersmith2, DN Bennett-Jones3, PA Mead3 & DM Large1
Cardiovascular disease is the leading cause of morbidity and mortality in patients with diabetic renal disease. We did a retrospective study on our Joint Diabetic-Renal clinic, which has run for 12 years, to see if we could reproduce targets from clinical trials and local guidelines in routine practice for management of cardiovascular risk. We collected data using clinical notes and electronic records on 133 patients. Our cohort included 62% type 2 and 38% type 1 Diabetics. Mean age at referral was 56 years. The mean duration of diabetes was 24 years in type 1 and 11 years for type 2 diabetics. Baseline median creatinine was 124micromol/l. (93 - 176). 88%had a history of hypertension and 44% had hyperlipidemia. 42% had history of ischaemic heart disease, 22% had cerebrovascular disease and 35% had peripheral vascular disease.65% needed 2 or more drugs for treatment of hypertension. The number of patients treated with ACE inhibitors improved from 56% to 64%. 23% had a recognised contraindication for ACE inhibitor therapy. 86% of patients with a history of dyslipidemia were treated and statins were prescribed in 93% of them. Mean systolic BP fell from 158 to 141(p<0.001), mean diastolic BP from 84 to 77(p<0.001) and Cholesterol from 5.9 to 5.3(p<0.001). HbA1C was maintained at 8.5%. 41(32%) patients died during the follow-up period.63% died due to cardiovascular disease, 15% secondary to renal failure and 22 % due to other causes. Univariate linear regression analysis was used to assess correlations between mortality and different parameters. A higher initial cholesterol, final cholesterol and age at presentation were found to predict mortality. This study of a clinic population has identified areas where significant improvements have been achieved in risk factor modification. It provides further evidence for target oriented approaches in specialist multidisciplinary clinics to achieve worthwhile clinical outcomes.