Endocrine Abstracts

JOINT1021

Background: T2D is associated with increased cardiovascular (CV) morbidity and mortality. ASCVD risk assessment can help to identify individuals with higher risk and optimizing treatment. This subgroup analysis of a retrospective, observational, multicentre, electronic medical record (EMR) based study (HEART STRONG STUDY) aimed to assess ASCVD risk in patients with T2D.

Methods: Aggregated and anonymised EMRs of patients aged 20-79 years, with total cholesterol (TC) 130-320 mg/dl, HDL 20-100 mg/dl and data available on T2D and smoking status and hypertension treatment were used to calculate ASCVD Risk Scores by American College of Cardiology Risk Estimator+. EMRs of patients with current or history of ASCVD were excluded. Primary endpoint was mean 10-year ASCVD risk. Here we present subgroup analysis of patients with T2D.

Results: Of total patients on EMR from 2017-2023, 4114 patients met eligibility criteria of which 3423 had T2D. Mean age was 55.8 years, BMI 26.89 kg/m² and 80% were males. Mean 10-year ASCVD risk score (n = 2777) was 17.8% vs 16.6% in overall study population. Risk was high, intermediate, borderline and low in 35.9 vs 32.6%, 34.9 vs 34.1%, 11.2 vs 11.9%, and 18 vs 21.3% in T2D vs overall study population. Mean Lifetime risk (n = 2115) was 54.6% and mean Optimal risk (n=3112) was 5.4%. Mean values of TC, LDL-C, HDL, VLDL, TG were 182.5 (n=3423), 103.7 (n = 3331), 42.6 (n = 3423), 28.4 (n = 2143), and 180.1 (n=3242) mg/dl respectively. Mean HbA1c was 9% (n = 2836), FBG was 168 mg/dl (n = 2868), PPBG was 248.65 mg/dl (n = 2703). Metformin (91%), Sulphonylurea (59%), DPP4i (53%), SGLT2i (19%) were most frequently prescribed antidiabetic drugs. Patient receiving >4, 4, 3, 2, 1 antidiabetic drugs were 18.9, 22.5, 24.0, 24.4, 9.9% respectively. Lipid lowering agents were prescribed to 56% patients.

Conclusion: In this T2D subgroup, almost every third patient had either high or intermediate ASCVD risk. Diabetes was poorly controlled despite multiple drugs which is likely to lead to poor CV outcomes. About half patients received lipid lowering agents and 19% received SGLT2i despite guideline recommendations. Adherence to guidelines and aggressive T2D treatment is urgently needed to reduce CV disease burden in Indian patients.