Type 2 diabetes and the individual perception of risk for cardiovascular death in coronary artery disease patients

Abstract Introduction Subjective feelings of patients regarding the likelihood of undesired disease outcomes can influence their behavior and medication adherence. Purpose The purpose of the study was to investigate the individual risk perception for cardiovascular (CV) death within 10 years in patients with coronary artery disease (CAD) confirmed at coronary angiography. Methods We included 445 consecutive patients with angiographically confirmed CAD in a tertiary care setting in central Europe. Prior to coronary angiography, patients were asked to rate their individual risk for CV death within the following 10 years in the categories very high, high, moderate or low, and to estimate a risk percentage between 0 and 100%. Results A response rate of 81.3% was achieved for the question with a categorial and 69.4% for that with a continuous response variable. From our patients, 155 (34.8%) had T2DM according to ADA criteria. Overall, patients with T2DM assessed their risk for CV death higher compared to those without diabetes, with allocations in the categories very high in 11.5% vs. 3.0%, high in 20.0% vs. 18.5%, moderate in 43.1% vs. 38.8% and low 25.4% vs. 39.7%, with a significant trend towards higher risk perception categories in T2DM (p=0.002). The median self-estimated risk for CV death over 10 years was 40% IQR:15-50 vs. 20% IQR:10-50 in patients with versus those without T2DM (p0.001). In analysis of covariance, T2DM (F=5.55; p=0.019) besides age (F=20.262; p0.001) and the number of drugs (F=9.65; p=0.002) independently predicted the risk perception of CV death after multivariable adjustment. Conclusion We conclude that CAD patients with T2DM estimate their individual risk for CV death higher than those without T2DM. Irrespective of T2DM status, there is a remarkable discrepancy between the level of risk CAD patients regard to represent very high, high, moderate or low risk and the definition of these risk categories in current guidelines.