Diabetes and Cardiovascular Events In High-Risk Patients: Insights from a Multicenter Registry in a Middle-Income Country

Abstract Aims The aim of this study was to determine the rate of major clinical events and its determinants in patients with previous cardiovascular event or not, and with or without diabetes from a middle-income country. Methods REACT study is a multicenter registry conducted between July 2010 and May 2013 in Brazil. Patients were eligible if they were over 45 years old and high cardiovascular risk. Patients were followed for 12 months; data were collected regarding adherence to evidence-based therapies and occurrence of clinical events (all-cause mortality, non-fatal cardiac arrest, myocardial infarction, or stroke). Results A total of 5006 subjects was included and analyzed in four groups: No diabetes and no previous cardiovascular event, n  = 430; diabetes and no previous cardiovascular event, n  = 1138; no diabetes and previous cardiovascular event, n  = 1747; and diabetes and previous cardiovascular event, n  = 1691. Major clinical events in one-year follow-up occurred in 332 patients. A previous cardiovascular event was associated with a higher risk of having another event in the follow-up (HR 2.31 95% CI 1.74–3.05, p p  = 0.005). In patients with diabetes, failure to reach HbA1c targets was related to poorer event-free survival compared to patients with good metabolic control (HR 1.70 95% CI 1.01–2.84, p  = 0.044). Conclusions In Brazil, diabetes confers high risk for major clinical events, but this condition is not equivalent to having a previous cardiovascular event. Moreover, not so strict targets for HbA1c in patients with diabetes and previous cardiovascular events might be considered.