Even with Cardiac Risk Factors, Non-CV Deaths More Common In Patients With Impaired Fasting Glucose

MedicalResearch.com Interview with:
Dr. Abhinav Sharma MD
Duke Clinical Research Institute, Duke University, Durham, NC
Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
Renato D. Lopes, MD, PhD, MHS
Duke Clinical Research Institute
Durham, NC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Impaired fasting glucose (IFG) has been demonstrated to be a risk factor for cardiovascular death; however, there is growing research suggesting that IFG also increases the risk of non-cardiovascular deaths such as cancer.

The data on the distribution of causes of death among patients with impaired fasting glucose and cardiovascular risk factors have not been described. Our analysis used data from the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial. We identified that while myocardial death is the most common adjudicated cause of death, overall, non-cardiovascular deaths were more common that cardiovascular deaths.

Among non-cardiovascular, cancer deaths were the most common cause of death. Furthermore, the burden of non-cardiovascular deaths increases relative to cardiovascular death over time.

MedicalResearch.com: What should readers take away from your report?

Response: The high burden of non-cardiovascular deaths has implications both clinically and for future trials. Clinically, patients with impaired fasting glucose and cardiovascular risk factors should be aggressively treated for cardiovascular risk factors; however, given the significant burden of non-cardiovascular deaths (and specifically cancer) in this population, clinicians need to also consider aggressive adherence to cancer screening based on guideline recommendations.

For cardiovascular clinical trials among patients with impaired fasting glucose and cardiovascular risk factors, the large burden of non-cardiovascular death must be considered as an important source of competing causes of death.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Further research is needed to identify better markers to risk stratify patients for specific causes of death. The presence of co-morbidities such as heart failure and atrial fibrillation have been shown across several disease states to increase the risk of cardiovascular death. Strategies to prevent the progression of patients with IFG from developing these co-morbidities will be critical to decrease the burden of mortality.

MedicalResearch.com: Is there anything else you would like to add?

Response: As the prevalence of impaired fasting glucose increases worldwide, strategies to decreases the burden of cardiovascular and non-cardiovascular mortality will be desperately needed. Our analysis represents a first step to better understanding the distribution of deaths in this population.

Disclosures: AS received grants from the Bayer-Vascular Canadian Cardiovascular Society research grant, the Alberta Innovates Health Solution Clinician Fellowship, and research support from Roche. RDL Disclosures available at https://www.dcri.org/about-us/conflict-of-interest.

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Non-Cardiovascular Deaths Are More Common than Cardiovascular Deaths in Patients with Cardiovascular Disease or Cardiovascular Risk Factors and Impaired Glucose Tolerance: Insights from the NAVIGATOR Trial

Abhinav Sharmaa, b, Flávio de Souza Britoa, Jie-Lena Suna, Laine Thomasa, Steven Haffnerc, Rury R. Holmand, Renato D. Lopesa,

American Heart Journal
Available online 29 December 2016

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