Death Risk Multiplied for Comorbid Diabetes, Stroke, Heart Attack

Patients with any combination of diabetes, stroke, or myocardial infarction (MI) have a significantly lower life expectancy than those with only 1 of these cardiometabolic conditions.

An analysis of more than 135,000 deaths across nearly 1.2 million participants determined that those with cardiometabolic multimorbidity had multiplicative mortality risk.

In other words, patients with a history of diabetes, stroke, and MI had about 8 times the rate of death compared with those who had no history of any of those 3 conditions. Patients with 2 conditions had roughly 4 times the rate of death, while those with only 1 condition had about twice the rate.

These reductions in life expectancy are similar to what has been observed for other major public health concerns, including lifelong smoking (10 years of reduced life expectancy) and HIV infection (11 years of reduced life expectancy).

The researchers saw even greater reductions among patients with cardiometabolic multimorbidity at younger ages. They estimated that those who had all 3 conditions by age 40 lived 23 fewer years than the reference group.

Lead study author Emanuele Di Angelantonio, MD, told Pharmacy Times that he was “somewhat surprised” by his findings.

“Previous research has mainly focused on individuals with [just] 1 cardiometabolic condition,” he said. “Given that the conditions we studied share several risk factors, it could be expected that a combination of these [conditions] would not be multiplicative.”

Since the results did show multiplicative mortality risk, Dr. Di Angelantonio said they “emphasize the importance of measures to prevent cardiovascular disease in people who already have diabetes and, conversely, to avert diabetes in people who already have cardiovascular disease.”

To achieve this, Laurence Sperling, MD, FACC, FACP, FAHA, chair of the American College of Cardiology cardiometabolic disease working group, told Pharmacy Times that a pharmacist’s role in managing this complex patient population will be “absolutely critical” given the growing prevalence of cardiometabolic multimorbidity.

Because of the “continued under-appreciation for medication adherence efforts and risks,” pharmacists “will be a key component of the clinical care team needed for total care support,” he explained.

The study authors advised against overemphasizing the considerable reductions in life expectancy in this patient population or “divert[ing] attention and resources away from population-wide strategies that aim to improve health for the large majority” of patients.

“We must not lose sight of tackling these serious problems within the wider population,” Dr. Di Angelantonio stressed to Pharmacy Times.

The study appeared in the July 7, 2015, issue of JAMA.