CLARIFY: Diabetes Poses Major Risk in Patients with Coronary Syndromes


An analysis of the CLARIFY registry is providing clinicians with further insight into the impact of diabetes in patients with chronic coronary syndromes, particularly the increased risk of stroke, myocardial infarction, and cardiovascular death.

This article was originally published on

Emmanuelle Vidal-Petiot, MD, PhD, of Bichat-Claude Bernard Hospital

Emmanuelle Vidal-Petiot, MD, PhD

Data from an analysis of the multinational CLARIFY registry is helping to paint a clearer picture of the relationship between coronary syndromes and diabetes.

The study found patients with chronic coronary syndromes were 3 times more likely to have diabetes and also revealed these patients were at a much greater risk of future cardiovascular events, including stroke, myocardial infarction, and cardiovascular death.

"Obesity and lack of exercise are common risk factors for both diabetes and heart disease and our results highlight the urgent need to improve nutrition and raise activity levels globally," said study lead investigator Emmanuelle Vidal-Petiot, MD, PhD, of Bichat-Claude Bernard Hospital, Paris, France, in a statement. "Countries worst affected by diabetes are also at the epicentre of the obesity epidemic, which can be in part attributed to urbanization and associated changes in physical activity and food intake."

Published on World Health Day, the study was conducted by Vidal-Petiot and a team of colleagues with the intent of further exploring the prognostic impact of diabetes in patients presenting with chronic coronary syndromes. With this in mind, the study was designed as an analysis of data from within the CLARIFY registry.

A prospective, international registry, CLARIFY provided investigators with information related to more than 30,000 patients with stable coronary artery disease from 45 middle- and high-income countries followed for 5 years beginning in 2009-2010. For inclusion in the registry, patients needed to have had a documented myocardial infarction more than 3 prior, coronary angiography revealing a blockage of 50% or more, history of CABG or PCI more than 3 months prior, or proven symptomatic myocardial ischemia.

Of note, multiple investigators of the current study were on the executive committee or served as investigators in the original CLARIFY study.

For the current analysis, investigators chose a composite outcome of cardiovascular death, myocardial infarction, and stroke as the primary outcome. Secondary outcomes for the analysis included each component of the primary outcome, total death, and hospitalization for heart failure.

After the exclusion of 9 patients from the CLARIFY registry due to lack of diabetes information, a cohort of 32,694 patients were identified for inclusion. Among these, 9502 (29%) had diabetes. Investigators noted the prevalence of diabetes ranged from 14% in Ireland to 67% in Saudi Arabia.

At the end of the 5-year follow-up period, 2807 patients had met the primary composite endpoint and 2544 patients had died, including 1619 who died from cardiovascular causes. When assessing secondary endpoints, investigators found stroke occurred in 686 patients, myocardial infarction occurred in 1106, 1647 patients were hospitalized for heart failure, and 2526 patients underwent coronary revascularization.

Upon analysis, all adverse clinical outcomes of interest occurred more frequently among patients diabetes. In adjusted analyses, patients with diabetes had a 28% greater risk for the primary composite outcome (aHR, 1.28; 95% CI, 1.18-1.39) and a greater risk for all secondary outcomes.

For secondary outcomes, patients with diabetes were at a 38% (HR, 1.38; 95% CI, 1.18-1.39) risk of all-cause death, a 39% (HR, 1.39; 95% CI, 1.25-1.54) greater risk of cardiovascular death, a 26% (HR, 1.26; 95% CI, 1.10-1.43) greater risk for myocardial infarction, a 29% (HR, 1.29; 95% CI, 1.09-1.52) greater risk of stroke, a 15% (HR, 1.15; 95% CI, 1.03-1.28) greater risk for hospitalization for heart failure, and a 14% (HR, 1.14; 95% CI, 1.04-1.25) greater risk of coronary revascularization.

"The importance of healthy eating and living cannot be overemphasized. Everyone can lower their chances of developing diabetes with weight control and exercise, and early detection is needed so that blood sugar can be controlled,” noted Vidal-Petiot. “Those with heart disease and diabetes also need an active lifestyle and a good diet to protect their health. Avoiding smoking is crucial, as is controlling blood pressure and cholesterol levels."

This study, “Prevalence of diabetes and impact on cardiovascular events and mortality in patients with chronic coronary syndromes, across multiple geographical regions and ethnicities,” was published in the European Journal of Preventive Cardiology.

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