Impact of diabetes mellitus on the clinical management of global cardiovascular risk: analysis of the results of the Evaluation of Final Feasible Effect of Control Training and Ultra Sensitization (EFFECTUS) educational program.

摘要

BACKGROUND: The Evaluation of Final Feasible Effect of Ultra Control Training and Sensitization (EFFECTUS) study is aimed at implementing global cardiovascular (CV) risk management in Italy. HYPOTHESIS: To evaluate the impact of diabetes mellitus (DM) on attitudes and preferences for clinical management of global CV risk among physicians treating diabetic or nondiabetic patients. METHODS: Involved physicians were asked to submit data into a study-designed case-report form, covering the first 10 adult outpatients consecutively seen in May 2006. All available clinical data were centrally analyzed for global CV risk assessment and CV risk profile characterization. Patients were stratified according to the presence or absence of DM. RESULTS: Overall, 1078 physicians (27% female, ages 50 +/- 7 y) collected data of 9904 outpatients (46.5% female, ages 67 +/- 9 y), among whom 3681 (37%) had a diagnosis of DM at baseline. Diabetic patients were older and had higher prevalence of obesity, hypertension, dyslipidemia, and associated CV diseases than nondiabetic individuals (P<0.001). They had higher systolic blood pressure, total cholesterol, triglycerides, and creatinine levels, but lower high-density lipoprotein cholesterol levels than nondiabetic patients (P<0.001). Higher numbers of blood pressure and lipid-lowering drugs and antiplatelet agents were used in diabetic than in nondiabetic patients (P<0.001). CONCLUSIONS: The EFFECTUS study confirmed higher CV risk and more CV drug prescriptions in diabetic than in nondiabetic patients. Presence of DM at baseline significantly improved clinical data collection. Such an approach, however, was not paralleled by a better control of global CV risk profile, which was significantly worse in the former than in the latter group.