Diabetes mellitus, hypertension and hypercholesterolemia in relation to the 10-year ACS prognosis; the GREECS study
Notara V., Panagiotakos DB., Michalopoulou M., Kouvari M., Tsompanaki E., Verdi M., Vassileiou N., Kalli E., Mantas Y., Kogias Y., Stravopodis P., Papanagnou G., Zombolos S., Pitsavos C., Antonoulas Y., Karanasios A., Rizos L., Mparmparoussis M., Kassimatis G., Giannopoulos G., Arapi S., Gialernios T., Massoura C., Sideris S., Daskalopoulos N., Stefanadis C., Papataxiarchis E., Tzanoglou D., Kouli G., Kouroupi S., Balli M., Tsomboli V., Chalamandaris A.
Although hypertension, hypercholesterolemia and diabetes mellitus (DM) are recognized as major cardio-metabolic risk factors in primary Acute Coronary Syndrome (ACS) prevention, studies focusing on secondary ACS incidence are scarce. In the present study, the association between the aforementioned factors and 10-year ACS prognosis was evaluated. From October 2003 to September 2004 2,172 consecutive patients with ACS diagnosis, from 6 Greek hospitals, were enrolled. During 2013-14, the 10-year follow-up was performed in 1,918 participants. Baseline clinical factors were assessed through physical examination, medical records and pharmacological management. All-cause mortality and the development of fatal or non-fatal ACS events were recorded through medical records or hospital registries. Logistic regression models were applied to evaluate the impact of baseline clinical status on the ACS prognosis. The 10-year all cause and ACS mortality rate was 32.6 and 17.8%, respectively. Multi-adjusted analysis highlighted that, after taking into account various potential confounders, DM was the sole clinical factor associated with adverse effect on the 10-year ACS fatal incidence [Odds Ratio (OR)=1.35, 95% Confidence Interval (95% CI) 1.01, 1.80, p=0.04]. DM was the only clinical factor that aggravated ACS prognosis, whereas abnormal lipids profile and blood pressure did not seem to determine prognosis. Thus, glycaemic control may play a critical role in the secondary CVD prevention management of ACS patients.