Riesgo cardiovascular en una cohorte de pacientes diabéticos del Centro de Salud "La Paz" de Badajoz seguidos durante 10 años

Abstract

Diabetes mellitus is a strong risk factor for cardiovascular disease, but its consideration as a coronary risk equivalent is questionable, leaving unclear whether it implies necessarily and automatically a cardiovascular secondary prevention actions. A 10-year follow-up, in the primary care center "La Paz" in Badajoz, of a cohort of 643 diabetic patients (mean age 64.0 years, 55.7% women, 16.2% illiterate, 67.7% with hypertension, 51.3% with obesity, 66.3% with dyslipidemia and 74.5% with metabolic syndrome), shows that the total coronary risk of the population was 14.5 %, i.e. lower than 20% of coronary events, the accepted threshold to consider diabetes as a coronary risk equivalent. The risk of total cardiovascular events was 32.7% (32.3 % in men and 33.0 % in women), confirming that diabetes tends to equalize the cardiovascular risk in both sexes. In this study, the presence of glycosylated hemoglobin levels ? 7% doubled the risk of cardiovascular death, while the presence of chronic renal disease, defined by estimation of the glomerular filtration rate with any of the formulas used, doubled the risk of coronary events and increased the mortality rate. Pharmacological strategies for cardiovascular secondary prevention were more prescribed in men, suggesting a negative discrimination against women in the adoption of these preventive actions. The original and the REGICOR Framingham functions overestimated and underestimated the coronary risk, respectively, thus questioning their usefulness as diagnostic aid instruments in the stratification of cardiovascular risk in diabetic patients.