Patient knowledge and management of major risk factors of HbA1c, blood pressure and LDL-C in coronary artery disease patients with and without diabetes mellitus: Results from the KNOW-ABC study

Maximilian Brockmeyer (Düsseldorf)1, M. Fell (Düsseldorf)1, C. Parco (Düsseldorf)1, A. Hoss (Düsseldorf)1, K. Vargas (Düsseldorf)1, Y. Heinen (Düsseldorf)1, C. Jung (Düsseldorf)1, M. Kelm (Düsseldorf)1, G. Wolff (Düsseldorf)1

1Universitätsklinikum Düsseldorf Klinik für Kardiologie, Pneumologie und Angiologie Düsseldorf, Deutschland


Background/Objective: Control of major drug-modifiable risk factors of glycated hemoglobin (HbA1c), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) remains unsatisfactory in secondary prevention of coronary artery disease (CAD). We aimed to analyze patient knowledge and attainment of HbA1c, BP, and LDL-C treatment goals in CAD patients with and without known diabetes mellitus (DM), since we hypothesized that patients with DM receive education from their treating physicians, which may have impact on treatment goal attainment of other risk factors. 

Methods: In a cross-sectional study, CAD patients were assessed for HbA1c, BP and LDL-C and completed a questionnaire assessing knowledge of treatment goals for HbA1c (<7.0%), BP (age-adapted according to ESC), and LDL-C (<55mg/dL) and subjective level of information on predefined topics of CAD. Additionally, patients answered questions on associated factors including duration of disease, adherence to pharmacotherapy (Rief adherence index), and specialty of the physician performing secondary prevention of CAD. 

Results: 204 CAD patients (age 68±8 years; 75.0% male; 84 with DM (41.2%), mean time since diagnosis 9.8±8 years) were included: Good adherence to pharmacotherapy was reported by 98.5%. HbA1c goals were attained by 48.8% of patients with DM. Treatment goals for BP were reached at considerable frequency (No DM 72.5% vs. DM 71.4%, p=0.87). LDL-C treatment goals were attained unsatisfactorily, but a lot more frequently by patients with DM (No DM 16.7% vs. DM 39.3%, p<0.01).

Correct knowledge of HbA1c goals was found in 53.6% of patients with DM (1.7% in patients without DM), knowledge of BP goals was found in 30.0% in No DM vs. 36.9% in DM patients (p=0.36), for LDL-C goal in 9.2% in No DM vs. 6.0% in DM patients (p=0.44). 

Patients reported that measurements of HbA1c and LDL-C were predominantly performed by general physicians ((GP) HbA1c: 71.4% GP, 3.6% cardiologist, 20.2% other; LDL-C: 81.4% GP, 10.8% cardiologist, 4.3% other).

Logistic regression revealed that DM (odds ratio (OR) 3.72, 95% confidence interval (CI) 1.82-7.61) and knowledge of LDL-C treatment goal were associated with attainment of LDL-C goal (OR 3.75, CI 1.16-12.09). No associated factors of attainment of HbA1c and BP treatment goals could be identified.

Conclusion: In CAD patients with and without DM, an alarming deficit of knowledge and attainment of treatment goals of LDL-C exists when compared to HbA1c (in patients with DM) and BP. CAD patients with DM attain LDL-C treatment goal more frequently than those without, indicating that education about one risk factor (DM) may influence goal attainment of another (LDL-C).

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