Comorbidity complicates cardiovascular treatment: is diabetes the exception?

BACKGROUND Many patients with cardiovascular disease do not attain the targets for health-related lifestyle and preventive treatment recommended in practice guidelines. The aim of this study was to assess the impact of diabetes (DM) and chronic obstructive pulmonary disease (COPD) on the quality of cardiovascular risk management in patients with established cardiovascular diseases (CVD). METHODS AND RESULTS Patients with established CVD were randomly selected in primary care practices using recorded diagnoses. Structured case forms were used to review data on 20 performance indicators concerning CVD from medical records. Descriptive and multilevel regression analyses were conducted. In 45 primary care practices with 106 physicians in the Netherlands, 1614 medical records of patients with CVD (37.9% women) were reviewed. A total of 1076 (66.7%) patients had recorded CVD only (reference group); 7.8% had CVD and COPD; 22.4% had CVD and DM; 3.1% patients had CVD, COPD and DM. Compared with the reference group, patients with CVD and DM yielded higher scores on 17 of 20 indicators; patients with CVD, DM and COPD on 14 indicators; and patients with CVD and COPD on three indicators. Of the patients with CVD and DM, fewer patients had LDL-cholesterol levels over 2.5 mmol/l (OR=0.36; 95% CI 0.26-0.50), more had antiplatelet drugs prescribed (OR=1.72; 95% CI 1.17-2.54), and more had systolic blood pressure measurement (OR=4.12; 95% CI 2.80-6.06). CONCLUSIONS This study showed that DM but not COPD was associated with more comprehensive cardiovascular risk management. This finding adds to cumulating evidence that presence of DM is associated with better preventive treatment of cardiovascular risk.