MI increasingly prevalent among T2D patients in Taiwan

The trend of cardiovascular (CV) events among patients with type 2 diabetes (T2D) in Taiwan declined consistently except for myocardial infarction (MI), which had increasing prevalence and incidence rates, according to a 10-year outline of CV disease patterns in T2D presented at APSC 2018.

From 2000–2010, the prevalence rates of stroke, heart failure (HF), and 5-year mortality decreased, said Dr Hsu Chih-Cheng from the National Health Research Institutes in Taipei, Taiwan. For hospitalized MI however, the rate increased by 22 percent (from 0.36 percent to 0.44 percent). [APSC 2018, abstract S008-02]

This is ‘a very big difference’ from US data according to Hsu, as it showed a 60-percent reduction in MI prevalence among patients with T2D (from 1.06 percent to 0.46 percent). Although the rates between US and Taiwan were similar by 2010 (0.46 percent vs 0.44 percent), it is important to note that the US rate was a decline whereas the Taiwan rate represented an increase in prevalence, Hsu pointed out. “Therefore, this is an area [we need] to focus on,” he said.

The 5-year incidence (2000–2005) of hospitalized MI also increased by 1.2 percent (from 4.04 to 4.09/1,000 person-years [PY]). Although this appears minimal, Hsu pointed out that MI was the only CV event that increased as opposed to the declining incidence in other events such as hospitalized ischaemic and haemorrhagic stroke (from 13.04 to 11.40/1,000 PY and 2.90 to 2.18/1,000 PY, respectively) and hospitalized HF (from 6.13 to 4.98/1,000 PY).

Diabetes is a CVD

The American Heart Association indicated that individuals with T2D are two to four times more likely to have a heart attack or stroke, and that it might be appropriate to state that “diabetes is a CVD”. [Circulation 1999;100:1134-1146]

“Based on this estimation … the American Medical Society made a very good effort to reduce [CVD],” noted Hsu, citing the 50-percent reduction in the prevalence of CV events as shown in previous studies. [JAMA 2004;292:2495-2499; N Engl J Med 2014;370:1514-1523]

In Taiwan, the incidence and prevalence of T2D has increased over the last 20 years, noted Hsu. “CVD is a very important complication of T2D,” he added. Therefore, it is important to employ preventive measures not just for T2D but also for CVD, particularly MI, due to the rising incidence and prevalence of MI, added Hsu.

Other challenges of T2D care

In addition to CV risk prevention, Hsu noted other important factors that need to be taken into consideration when addressing other challenges of T2D care.

Individuals in the low socioeconomic sector are more likely to develop T2D due to inadequate means for consultations and follow-ups, said Hsu. “They cannot [obtain] prompt diagnosis and … are less likely to undergo the necessary diabetes-related tests.”

Other challenges are the early diabetes onset in the younger generation as well as inadequate insulin use, as only 12 percent of patients with T2D use insulin, he added.

Given these challenges, Hsu highlighted the importance of patient education and programmes that can provide quality care for T2D. Moreover, it is also important for physicians to foster collaborations with diabetes associations and related specialists (ie, cardiologists, endocrinologists, epidemiologists) to consistently monitor diabetes incidence and prevalence, as well as the CVD patterns in T2D, in order to provide the appropriate care for their patients.