Screening for Glucose Perturbations and Risk Factor Management in Dysglycemic Patients With Coronary Artery Disease—A Persistent Challenge in Need of Substantial Improvement: A Report From ESC EORP EUROASPIRE V

Authors: Giulia Ferrannini, Dirk De Bacquer, Guy De Backer, Kornelia Kotseva, Linda Mellbin, David Wood, Lars Rydén, EUROASPIRE V collaborators, Chris P Gale, Branko Beleslin, Andrzej Budaj, Ovidiu Chioncel, Nikolaos Dagres, Nicolas Danchin, David Erlinge, Jonathan Emberson, Michael Glikson, Alastair Gray, Meral Kayıkçıoğlu, Aldo P. Maggioni, Klaudia Vivien Nagy, Aleksandr Nedoshivin, Anna-Sonia Petronio, Jolien W. Roos‐Hesselink, Lars Wallentin, Uwe Zeymer, Kornelia Kotseva, Guy De Backer, Ana Abreu, Carlos Aguíar, Jolita Badarienė, Jan Bruthans, Almudena Castro Conde, Renata Cífková, Jim Crowley, Kairat Davletov, Dirk De Bacquer, Delphine De Smedt, Johan De Sutter, Jaap W. Deckers, Mirza Dilić, Maryna Dolzhenko, H. Druais, Vilnis Dzērve, Andrejs Ērglis, Zlatko Fras, Dan Gaiță, Nina Gotcheva, Diederick E. Grobbee, Viveca Gyberg, Hosam Hasan Ali, Peter U. Heuschmann, Arno W. Hoes, Piotr Jankowski, Nebojša Lalić, Seppo Lehto, Dragan Lović, S. Mancas, Pedro Marques‐Vidal, Linda Mellbin, Davor Miličić, Erkin М Мirrakhimov, Oganov Rg, Nana Pogosova, Željko Reiner, Lars Rydén, Martin Stagmo, Stefan Störk, Jouko Sundvall, Lâle Tokgözoğlu, Costas Tsioufis, Duško Vulić, David Wood, Arno W. Hoes, Catriona Jennings, Agnieszka Adamska, S. Adamska, L.J. Tuomilehto, Oliver Schnell, Laura Råman, Anne‐Marie Willems, Michel De Pauw, Pieter Vervaet, Jessa Ziekenhuis, J. Bollen, E. Dekimpe, N. Mommen, G. Van Genechten, Paul Dendale, Audrey Bouvier, Patrick Chenu, D. Huyberechts, Alexandre Persu, Alden Begić, Azra Durak-Nalbantić, Alen Džubur, N. Hadzibegic, Amer Iglica, S. Kapidjic, A. Osmanagic Bico, Nerma Resić, Nirvana Šabanović-Bajramović, Faris Zvizdić, Tamara Kovačević-Preradović, S. Popovic-Pejicic, Danijel Djekic, T. Gnjatic, Tamara Knežević, Ljiljana Kos, S. Popovic-Pejicic, Bojan Stanetić, G. Topic, B. Georgiev, A. Terziev, G. Vladimirov, A Angelov, Branimir Kanazirev, С.В. Николаева, Dilyana Tonkova, M. Vetkova, A. Bosnic, Mia Dubravčić, M. Glavina, Marija Mance, Saša Pavasović, Jure Samardžić, Tonči Batinić, K. Crljenko, Diana Delić-Brkljačić, K. Dula, Karlo Golubić, Iva Klobučar, Krešimir Kordić, Nikola Kos, Mislav Nedić, D. Olujic, V. Sedinic, Tea Blažević, Ante Pašalić, Marko Perčić, J. Sikic, K. Hašplová, Pavel Šulc, Peter Wohlfahrt, Otto Mayer, Martina Cvíčela, Jan Filipovský, Július Gelžinský, Markéta Hronová, S. Bakery, Eman Mosad, Hosny B. Hamed, A. Ibrahim, M Abdelfatah Elsharef, Emad Farah Kholef, Azhar Abdel–Fatah Mohamed Shehata, Mostafa Youssef, Ehab El-Hefny, Hoda M. Farid, Tamer Moustafa, M.S. Sobieh, Hamza Kabil, A. Abdelmordy, E. Kiljander, P. Kiljander, Heli Koukkunen, Juha Mustonen, C. Cremer, Stefan Frantz, Axel Haupt, Ulrich Hofmann, Karin Ludwig, Hannes Melnyk, Michel Noutsias, W. Karmann, Roland Prondzinsky, Christian Herdeg, Tobias Hövelborn, A. Daaboul, Tobias Geisler, T.T. KELLER, D. Sauerbrunn, M. Walz-Ayed, Georg Ertl, Rainer Leyh, Tobias Ehlert, Bernward Klocke, J. Krapp, T. Ludwig, J. Käs, C. Starke, Kathrin Ungethüm, Martin Wagner, Silke Wiedmann, P. Tolis, Georgia Vogiatzi, Elias Sanidas, Konstantinos Tsakalis, John Kanakakis, Athanasios Koutsoukis, K Vasileiadis, John Zarifis, C. Karvounis, Irene Gibson, Ailish Houlihan, C. Kelly, Martin O’Donnell, M. Bennati, F Cosmi, Beatrice Mariottoni, M. Morganti, Antonio Cherubini, Andrea Di Lenarda, Donatella Radini, Federica Ramani, Maura Francese, Michele Massimo Gulizia, D. Pericone, K. Aigerim, Z. Bekbolat, B Amirov, Batyrbek Assembekov, E. Chernokurova, F Ibragimova, Almat Kodasbayev, Alexandra Markova, A. Asanbaev, Ulan M. Toktomamatov, M. Tursunbaev, U. Zakirov, S. Abilova, Rano Arapova, E. Bektasheva, J. Esenbekova, K Neronova, K. Baigaziev, Г. М. Баитова, T. Zheenbekov, T. Andrejeva, Iveta Bajāre, G. Kucika, A. Labuce, L. Putane, M. Stabulniece, E. Klavins, Iveta Sime, L. Gedvilaite, D. Pečiuraite, Virginija Šileikienė, E. Skiauteryte, Svetlana Solovjova, R. Sidabraite, Kasparas Briedis, Indrė Čeponienė, Martynas Jurėnas, Justas Keršulis, G. Martinkute, Audronė Vaitiekienė, Kristina Vasiljevaitė, R. Veisaite, Jurgita Plisienė, V. Šiurkaitė, Žilvinas Vaičiulis, Danuta Czarnecka, Paweł Kozieł, Piotr Podolec, Jadwiga Nessler, Piotr Gomuła, Ewa Mirek-Bryniarska, Piotr Bogacki, Andrzej Wiśniewski, Andrzej Pająk, Renata Wolfshaut–Wolak, J. Bućko, Karol Kamiński, Magda Łapińska, Marlena Paniczko, Andrzej Raczkowski, Emilia Sawicka, Zofia Stachurska, Małgorzata Szpakowicz, W Musiał, Sławomir Dobrzycki, Jerzy Bychowski, Dariusz A. Kosior, Agnieszka Krzykwa, Małgorzata Setny, Arkadiusz Rak, Zbigniew Gąsior, Maciej Haberka, Karolina Szóstak-Janiak, M. Finik, J. Liszka, Ana Botelho, Maria Luz Cachulo, José Américo Gomides de Sousa, A. Pais, A Durazzo, Daniel Matos, Raquel Gouveia, Guilherme Silva Rodrigues, C Strong, Rui Guerreiro, Carlos Aguíar, Martha L. Cruz, Pedro Daniel, Lucas Bittar de Morais, Rafaella Pessoa Moreira, Suélia de Siqueira Rodrigues Fleury Rosa, Sónia Rodrigues, Mafalda Selas, A. Apostu, Oana Catalina Cosor, L. Gaita, L. Giurgiu, C. Hudrea, Daniela Maximov, Bogdan Moldovan, Svetlana Moșteoru, Roxana Pleavă, M Ionescu, Irinel-Raluca Parepa, A. G. Arutyunov, A. K. Ausheva, С. С. Исакова, А. В. Карпова, A. O. Salbieva, O. Y. Sokolova, A. Vasilevsky, Yu. M. Pozdnyakov, О. Н. Антропова, L. Borisova, И. В. Осипова, Milica Aleksić, Bogdan Crnokrak, J. Hadzi Djokic, Saša Hinić, T. Vukasin, Marija Zdravković, Aleksandra Jotić, Katarina Lalić, Ljiljana Lukić, Tanja Miličić, Marija Maćešić, J. StanarcicGajovic, Milica Stoiljković, Dragan Djordjević, S. Kostić, I. Tasić, Ana Vuković, Borut Jug, A. Juhant, A. Krt, U. Kugonjič, David Chipayo Gonzales, José Javier Gómez-Barrado, Zineb Kounka, Germán Gómez, María Victoria Mogollón Jiménez, Carolina Ortíz Cortés, Paloma Pérez Espejo, Y. Porras Ramos, Ricki J. Colman, J. Delgado, Enrique Barrueco Otero, Antonio Pérez, M. Rosa Fernández-Olmo, Javier Torres-Llergo, C. Vasco, E. Barreñada, Javier Botas, Raquel Campuzano, Y. González, P. Rodrigo, Carmen de Pablo, Elena Velasco, S. Hernández, Cristina Arias Lozano, Paula González, Regina Dalmau, D. Hernández, Francisco Javier Irazusta, Andrea Vélez, C. Vindel, Juan José Gómez‐Doblas, Victoria Garcia-Ruiz, Luis M. Gómez, María Gómez García, Manuel F. Jiménez‐Navarro, Ana Isabel Molina-Ramos, Domingo Marzal, Gonzalo Martínez, Rafael Hernández Lavado, A. Vidal, V. Boström-Nilsson, Barbro Kjellström, Bahira Shahim, Stina Smetana, O. Hansen, E. Stensgaard-Nake, Aart J. Klijn, T.J.P. Mangus, Ron Peters, Wilma Scholte op Reimer, Marjolein Snaterse, S. Aydoğdu, Çetin Erol, Sezgin Öztürk, Cansın Tulunay Kaya, Y. Ahmetoğlu, O Ergene, Bahri Akdeniz, D Cirgamis, S. Akkoyun H. Kültürsay, Meral Kayıkçıoğlu, Alp Burak Çatakoğlu, Atiye Çengel, Ajar Koçak, M.A. Ağırbaşlı, Gönül Açıksarı, Muhammed Esad Çekin, Elif Kaya, Duygu Koçyiğit, Zeki Öngen, Emre Özmen, Vedat Sansoy, Ayşem Kaya, Veysel Oktay, Ahmet Temizhan, Sefa Ünal, İdris Yakut, Ali Kemal Kalkan, Engin Bozkurt, Hacı Ahmet Kasapkara, C. Faradzh, L. M. Hrubyak, L. Konoplianyk, N. Kozhuharyova, L. Ye. Lobach, V. Nesukai, Oleksandr O. Nudchenko, T V Simagina, L.F. Yakovenko, V. Je. Azarenko, V. Potabashny, Andriy Bazylevych, M. Bazylevych, Katarzyna Kamińska, Panchenko Lf, O. Shershnyova, T. Ovrakh, S. A. Serik, T. Kolesnik, Г.А. Косова, A. Hoye P. Atkin, D. Fellowes, Suzanne Lindsay, Charlotte Atkinson, C. Kranilla, M. Vinod, H Abbass, N. Rhoualmi, Y. Beerachee, C. Bennett, Matthew R. Broome, Angela Gono Bwalya, Lindsay Caygill, L. Dinning, Alexander Gillespie, R. Goodfellow, Julien Guy, T. Idress, Charlotte Mills, Cindy Morgan, N. Oustance, Narendra Singh, M. Yare, Jayathri Jagoda, Helen Bowyer, Victoria Christenssen, AM Groves, A. Jan, Amna Riaz, Max Gill, T Sewell, Diana A. Gorog, Mark Baker, P. De Sousa, T. Mazenenga, Jody Porter, F. Haines, Tim Peachey, J. Taaffe, Kristen J. Wells, David P Ripley, H. Forward, H McKie, Sara Pick, Huw B. Thomas, Phillip D Batin, D. Exley, T. Rank, Jim Wright, A Kardos, S.-B. Sutherland, L. Wren, P.A. Leeson, David J. Barker, B. Moreby, Janet K. Sawyer, James Stirrup, Margaret Brunton, Adrian Brodison, J. Craig, SAE Peters, Raffi Kaprielian, A. Bucaj, Kanta Mahay, Maja Ravnik Oblak, Chris P Gale, Maurice Pye, Yvonne McGill, H. Redfearn, M. E. Fearnley - Diabetes Care 2020 cited by 79

OBJECTIVE Dysglycemia, in this survey defined as impaired glucose tolerance (IGT) or type 2 diabetes, is common in patients with coronary artery disease (CAD) and associated with an unfavorable prognosis. This European survey investigated dysglycemia screening and risk factor management of patients with CAD in relation to standards of European guidelines for cardiovascular subjects. RESEARCH DESIGN AND METHODS The European Society of Cardiology’s European Observational Research Programme (ESC EORP) European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V (2016–2017) included 8,261 CAD patients, aged 18–80 years, from 27 countries. If the glycemic state was unknown, patients underwent an oral glucose tolerance test (OGTT) and measurement of glycated hemoglobin A1c. Lifestyle, risk factors, and pharmacological management were investigated. RESULTS A total of 2,452 patients (29.7%) had known diabetes. OGTT was performed in 4,440 patients with unknown glycemic state, of whom 41.1% were dysglycemic. Without the OGTT, 30% of patients with type 2 diabetes and 70% of those with IGT would not have been detected. The presence of dysglycemia almost doubled from that self-reported to the true proportion after screening. Only approximately one-third of all coronary patients had completely normal glucose metabolism. Of patients with known diabetes, 31% had been advised to attend a diabetes clinic, and only 24% attended. Only 58% of dysglycemic patients were prescribed all cardioprotective drugs, and use of sodium–glucose cotransporter 2 inhibitors (3%) or glucagon-like peptide 1 receptor agonists (1%) was small. CONCLUSIONS Urgent action is required for both screening and management of patients with CAD and dysglycemia, in the expectation of a substantial reduction in risk of further cardiovascular events and in complications of diabetes, as well as longer life expectancy.