Endocrine Abstracts

Background: Atherosclerotic cardiovascular disease (ASCVD) is a major complication to type 2 diabetes (T2D), in terms of both severity and prevalence rates. The Prevalence and clinical management of the Atherosclerotic Cardiovascular Diseases in patients with Type 2 Diabetes across Middle East and Africa countries (PACT-MEA) is a multinational study that aimed to investigate the prevalence of both established ASCVD and the risk for ASCVD in people with T2D as well as its clinical management in seven countries in the Middle East and Africa. Herein, we report the results for Egypt.

Methods: This is an observational, multicenter, cross-sectional study that involved medical charts review of adults with T2D for >180 days. Data was collected from eight secondary care centers across Egypt during a single scheduled visit in the period between July and August 2022. Complete medical history, demographics, laboratory, and pharmacotherapy data were collected to determine their ASCVD risk status and report on their clinical management. ASCVD was defined as the presence of coronary, cerebrovascular, or peripheral artery disease. High risk of ASCVD was defined according to risk criteria as per the European Society of Cardiology (ESC) 2021 guidelines.¹

Results: A total of 550 adults with T2D were enrolled by the end of the study period. The mean (standard deviation [SD]) age was 54.5 (10.5) years, with a mean T2D duration of 9.3 (7.5) years and a mean HbA1c of 8.3% (2.1). Prevalence of established ASCVD was 19.6% (95% confidence interval [CI]; 16.5, 23.2) with a prevalence of 15.1% for coronary artery disease, 3.1% for cerebrovascular disease, and 2.9% for peripheral artery disease. In people without established ASCVD, prevalence of high ASCVD risk was estimated at 85.5% (95% CI: 81.9, 88.5). The weighted distribution of cardiovascular risk categories according to the 2021 ESC guidelines revealed that 27 % were classified as very high risk, 72.1% as high risk and only 0.9% as moderate Risk. Only 20% were receiving sodium glucose cotransporter 2 inhibitors, and 3% were receiving glucagon like peptide-1 analogues.

Conclusion: Egyptian adults with T2D present high prevalence of both established ASCVD and high risk/very high risk of ASCVD; a status that is accompanied by a lack of implementation of the guideline-recommended pharmacotherapy approaches and life-style modifications. Consequently, nation-wide initiatives to address the highlighted gaps in T2D management in Egypt are highly recommended.

Reference: 1. Visseren, F.L. et al. (2021), European Heart Journal, 42(34), pp. 3227–3337.