Turk Kardiyol Dern Ars. 2009; 37(4): 221-225

The impact of diabetes and coronary artery disease on mortality and morbidity in patients with hypertension

Aytekin Oğuz¹, Taner Damcı², Seçkin Pehlivanoğlu³, Hakan Kültürsay⁴, Lale Tokgözoğlu⁵, Mustafa Şenocak⁶, Mehmet Yusuf^7
1Department of Internal Medicine, Göztepe Training and Research Hospital, İstanbul
²Department of Internal Medicine, Cerrahpaşa Medical School of İstanbul University, İstanbul
³Department of Cardiology, Cerrahpaşa Medical School of İstanbul University, İstanbul
⁴Departments of Biostatistics, Cerrahpaşa Medical School of İstanbul University, İstanbul
⁵Department of Cardiology, Medicine Faculty of Ege University, İzmir
⁶Department of Cardiology, Medicine Faculty of Hacettepe University, Ankara
⁷Altis Medical Research Organization, İstanbul

OBJECTIVES
We evaluated the impact of diabetes mellitus (DM) and/or coronary artery disease (CAD) on cardiovascular endpoints in a cohort of hypertensive patients.

STUDY DESIGN
The Vascular Risk Study is a cross-sectional, multicenter, observational study conducted among 5,600 patients from various regions of Turkey. This analysis included 2,664 patients (1,643 women, 1,021 men; mean age 65.3 years; range 55-99 years) whose follow-up data were adequate among a population of 4,506 hypertensive subjects. Cardiovascular primary and secondary endpoints at the end of a five-year follow-up were assessed in patients who had hypertension alone, and in those having DM and/or CAD. Information on the cause of death was obtained from the relatives of the patients by follow-up phone calls.

RESULTS
There were 1,171 patients (44%) with isolated hypertension, 631 (23.7%) with DM, 530 (19.9%) with CAD, and 332 (12.5%) with both DM and CAD. The presence of either DM or CAD was associated with significant increases in the incidences of all endpoints. The occurrences of primary and secondary endpoints, cardiovascular death, and all death were similar in hypertensive patients who had DM without CAD and in patients who had CAD without DM. In survival analysis, the incidence of cardiovascular death was lowest (5.7%) in hypertensive patients without DM and CAD, and highest (18.4%) in hypertensive patients with DM and CAD. The cumulative survival rates were similar in hypertensive patients with either DM or CAD alone (p>0.05).

CONCLUSION
This study demonstrated that the level of cardiovascular risk associated with DM was equal to the risk associated with CAD in hypertensive patients and that the coexistence of DM and CAD in these patients increases the risk geometrically.

Keywords: Cardiovascular diseases/epidemiology, coronary artery disease/epidemiology, diabetes mellitus/epidemiology, hypertension/complications/epidemiology; risk factors.

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