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Published in: BMC Cardiovascular Disorders 1/2015

Open Access 01-12-2015 | Research article

Comparison of treatment outcomes in patients with and without diabetes mellitus attending a multidisciplinary cardiovascular prevention programme (a retrospective analysis of the EUROACTION trial)

Authors: Sandra N Ofori, Kornelia Kotseva

Published in: BMC Cardiovascular Disorders | Issue 1/2015

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Abstract

Background

The objective was to compare the improvements in lifestyle and risk factor profiles in patients with and without diabetes mellitus (DM) in the intervention arm of EUROACTION study.

Methods

This was a retrospective analysis of the intervention arm of EUROACTION trial. Primary outcome was proportions meeting the European targets for not smoking, diet, physical activity (PA), body mass index (BMI), waist circumference (WC), blood pressure (BP), total and low-density lipoprotein (LDL) cholesterol and cardio-protective drug use at one year.

Results

179 and 777 coronary patients with and without DM, and 340 and 917 high-risk individuals (HRI) with and without DM, respectively were identified. The proportions of coronary patients achieving the lifestyle targets improved from the initial assessment (IA) except non-smoking, which reduced. At one year, significantly fewer patients with DM attained the targets for BMI (13.2% vs 31.3%, p = 0.002) and BP <140/90 mmHg (53.5% vs 74.0%, p < 0.001) compared to patients without DM despite a higher proportion of patients with DM prescribed angiotensin converting enzyme inhibitors/angiotensin receptor blockers (79.1% vs 65.3%, p = 0.021).
Among the HRIs, fewer patients with DM achieved targets for oily fish intake (9.3% vs 11.9%, p = 0.043), physical activity (65.8% vs 75.8%, p = 0.011), and BMI (9.9% vs 28.1%, p = 0.022) at one year. While more patients with DM achieved the targets for total cholesterol (48.2% vs 22.9%, p < 0.001) and LDL (57.9% vs 30.7%, p < 0.001).

Conclusions

Multidisciplinary intervention had a beneficial effect on several cardiovascular risk factors in both patients with and without DM. Poorer achievement of mostly lifestyle (and BP in coronary patients) targets among those with DM emphasises the need for more intensive lifestyle modification and BP management for the prevention of cardiovascular disease.
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Literature
1.
go back to reference NICE. National Institute for Health and Clinical Excellence. Type 2 diabetes: full guideline 2008, guidance.nice.org.uk/CG66/guidance (2008, accessed 31 May 2013). NICE. National Institute for Health and Clinical Excellence. Type 2 diabetes: full guideline 2008, guidance.nice.org.uk/CG66/guidance (2008, accessed 31 May 2013).
2.
go back to reference Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993;16(2):434–44.PubMed Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993;16(2):434–44.PubMed
3.
go back to reference Morrish N, Wang SL, Stevens L, Fuller J, Keen H. Mortality and uses of death in the WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia. 2001;44:14–21. Morrish N, Wang SL, Stevens L, Fuller J, Keen H. Mortality and uses of death in the WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia. 2001;44:14–21.
4.
go back to reference Rydén L, Standl E, Bartnik M, Van den Berghe G, Betteridge J, De Boer M, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J. 2007;28(1):88–136.PubMed Rydén L, Standl E, Bartnik M, Van den Berghe G, Betteridge J, De Boer M, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J. 2007;28(1):88–136.PubMed
5.
go back to reference Perk J, De Backer G, Gohlke H, Graham I, Reiner Ž, Verschuren M, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2012;33(13):1635–701.PubMed Perk J, De Backer G, Gohlke H, Graham I, Reiner Ž, Verschuren M, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2012;33(13):1635–701.PubMed
6.
go back to reference Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Keil U. Lifestyle and risk-factor management and use of drug therapies in coronary patients from 15 countries. Eur Heart J. 2001;22(7):554–72. Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Keil U. Lifestyle and risk-factor management and use of drug therapies in coronary patients from 15 countries. Eur Heart J. 2001;22(7):554–72.
7.
go back to reference Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Keil U. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil. 2009;16(2):121–37.PubMed Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Keil U. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil. 2009;16(2):121–37.PubMed
8.
go back to reference Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Keil U. Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries. The Lancet. 2009;373(9667):929–40. Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Keil U. Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries. The Lancet. 2009;373(9667):929–40.
9.
go back to reference Pyörälä K, Lehto S, De Bacquer D, De Sutter J, Sans S, Keil U, et al. Risk factor management in diabetic and non-diabetic patients with coronary heart disease. Findings from the EUROASPIRE I AND II surveys. Diabetologia. 2004;47(7):1257–65.PubMed Pyörälä K, Lehto S, De Bacquer D, De Sutter J, Sans S, Keil U, et al. Risk factor management in diabetic and non-diabetic patients with coronary heart disease. Findings from the EUROASPIRE I AND II surveys. Diabetologia. 2004;47(7):1257–65.PubMed
10.
go back to reference Gæde P, Lund-Andersen H, Parving H, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med. 2008;358(6):580–91.PubMed Gæde P, Lund-Andersen H, Parving H, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med. 2008;358(6):580–91.PubMed
11.
go back to reference Wood D, Kotseva K, Jennings C, Mead A, Jones J, Holden A, et al. EUROACTION: A European Society of Cardiology demonstration project in preventive cardiology. A cluster randomised controlled trial of a multi-disciplinary preventive cardiology programme for coronary patients, asymptomatic high risk individuals and their families. Summary of design, methodology and outcomes. Eur Heart J Suppl. 2004;6(Supp J):J3–15. Wood D, Kotseva K, Jennings C, Mead A, Jones J, Holden A, et al. EUROACTION: A European Society of Cardiology demonstration project in preventive cardiology. A cluster randomised controlled trial of a multi-disciplinary preventive cardiology programme for coronary patients, asymptomatic high risk individuals and their families. Summary of design, methodology and outcomes. Eur Heart J Suppl. 2004;6(Supp J):J3–15.
12.
go back to reference Wood D, Kotseva K, Connolly S, Jennings C, Mead A, Jones J, et al. Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: A paired, cluster-randomised controlled trial. The Lancet. 2008;371(9629):1999–2012. Wood D, Kotseva K, Connolly S, Jennings C, Mead A, Jones J, et al. Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: A paired, cluster-randomised controlled trial. The Lancet. 2008;371(9629):1999–2012.
13.
go back to reference Murchie P, Campbell NC, Ritchie LD, Simpson JA, Thain J. Secondary prevention clinics for coronary heart disease: four year follow up of a randomised controlled trial in primary care. Br Med J. 2003;326(7380):84. Murchie P, Campbell NC, Ritchie LD, Simpson JA, Thain J. Secondary prevention clinics for coronary heart disease: four year follow up of a randomised controlled trial in primary care. Br Med J. 2003;326(7380):84.
14.
go back to reference Chow CK, Jolly S, Rao-Melacini P, Fox KAA, Anand SS, Yusuf S. Association of Diet, Exercise, and Smoking Modification With Risk of Early Cardiovascular Events After Acute Coronary Syndromes. Circulation. 2010;121(6):750–8.PubMed Chow CK, Jolly S, Rao-Melacini P, Fox KAA, Anand SS, Yusuf S. Association of Diet, Exercise, and Smoking Modification With Risk of Early Cardiovascular Events After Acute Coronary Syndromes. Circulation. 2010;121(6):750–8.PubMed
15.
go back to reference Janssen V, De Gucht V, Dusseldorp E, Maes S. Lifestyle modification programmes for patients with coronary heart disease: A systematic review and meta-analysis of randomized controlled trials. Eur J Prev Cardiol. 2013;20(4):620–40. Available from doi: 10.1177/2047487312462824 (2013, accessed 15 July 2013).PubMed Janssen V, De Gucht V, Dusseldorp E, Maes S. Lifestyle modification programmes for patients with coronary heart disease: A systematic review and meta-analysis of randomized controlled trials. Eur J Prev Cardiol. 2013;20(4):620–40. Available from doi: 10.1177/2047487312462824 (2013, accessed 15 July 2013).PubMed
16.
go back to reference Fowler P, Hoskins P, McGill M, Dutton S, Yue D, Turtle J. Anti‐smoking Programme for Diabetic Patients: The Agony and the Ecstasy. Diabet Med. 1989;6(8):698–702.PubMed Fowler P, Hoskins P, McGill M, Dutton S, Yue D, Turtle J. Anti‐smoking Programme for Diabetic Patients: The Agony and the Ecstasy. Diabet Med. 1989;6(8):698–702.PubMed
17.
go back to reference Mozaffarian D, Rimm EB. Fish intake, contaminants, and human health. JAMA. 2006;296(15):1885–99.PubMed Mozaffarian D, Rimm EB. Fish intake, contaminants, and human health. JAMA. 2006;296(15):1885–99.PubMed
18.
go back to reference British Heart Foundation publication 2013. New guidance will help improve care for heart attack patients www.bhf.org.uk. (Accessed 2 August 2013). British Heart Foundation publication 2013. New guidance will help improve care for heart attack patients www.​bhf.​org.​uk. (Accessed 2 August 2013).
19.
go back to reference Wood D, De Backer G, Faergeman O, Graham I, Mancia G, Pyörälä K. Prevention of coronary heart disease in clinical practice: Recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention Original Research Article. Atherosclerosis. 1998;140(2):199–270.PubMed Wood D, De Backer G, Faergeman O, Graham I, Mancia G, Pyörälä K. Prevention of coronary heart disease in clinical practice: Recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention Original Research Article. Atherosclerosis. 1998;140(2):199–270.PubMed
20.
go back to reference Newby PK, Muller D, Hallfrisch J, Qiao N, Andres R, Tucker KL. Dietary patterns and changes in body mass index and waist circumference in adults. Am J Clin Nutr. 2003;77(6):1417–25.PubMed Newby PK, Muller D, Hallfrisch J, Qiao N, Andres R, Tucker KL. Dietary patterns and changes in body mass index and waist circumference in adults. Am J Clin Nutr. 2003;77(6):1417–25.PubMed
21.
go back to reference Tranche S, Galgo A, Mundet X, Sanchez-Zamorano MA. Cardiovascular risk factors in type 2 diabetic patients: multifactorial intervention in primary care. Kidney Int. 2005;67:S55–62. Tranche S, Galgo A, Mundet X, Sanchez-Zamorano MA. Cardiovascular risk factors in type 2 diabetic patients: multifactorial intervention in primary care. Kidney Int. 2005;67:S55–62.
22.
go back to reference Di Loreto C, Fanelli C, Lucidi P, Murdolo G, De Cicco A, Parlanti N, et al. Make Your Diabetic Patients Walk Long-term impact of different amounts of physical activity on type 2 diabetes. Diabetes Care. 2005;28(6):1295–302.PubMed Di Loreto C, Fanelli C, Lucidi P, Murdolo G, De Cicco A, Parlanti N, et al. Make Your Diabetic Patients Walk Long-term impact of different amounts of physical activity on type 2 diabetes. Diabetes Care. 2005;28(6):1295–302.PubMed
23.
go back to reference Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus. JAMA. 2001;286(10):1218–27.PubMed Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus. JAMA. 2001;286(10):1218–27.PubMed
24.
go back to reference Wing R. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010;170(17):1566–75.PubMed Wing R. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010;170(17):1566–75.PubMed
25.
go back to reference Nyenwe EA, Jerkins TW, Umpierrez GE, Kitabchi AE. Management of type 2 diabetes: evolving strategies for the treatment of patients with type 2 diabetes. Metabolism. 2011;60(1):1–23.PubMedPubMedCentral Nyenwe EA, Jerkins TW, Umpierrez GE, Kitabchi AE. Management of type 2 diabetes: evolving strategies for the treatment of patients with type 2 diabetes. Metabolism. 2011;60(1):1–23.PubMedPubMedCentral
26.
go back to reference Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts). Eur Heart J. 2007;28(19):2375–414.PubMed Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts). Eur Heart J. 2007;28(19):2375–414.PubMed
27.
go back to reference McBrien K, Rabi DM, Campbell N, Barnieh L, Clement F, Hemmelgarn BR, et al. Intensive and Standard Blood Pressure Targets in Patients With Type 2 Diabetes Mellitus- Systematic Review and Meta-analysis of BP Targets in Patients With DM. Arch Intern Med. 2012;172(17):1296–303.PubMed McBrien K, Rabi DM, Campbell N, Barnieh L, Clement F, Hemmelgarn BR, et al. Intensive and Standard Blood Pressure Targets in Patients With Type 2 Diabetes Mellitus- Systematic Review and Meta-analysis of BP Targets in Patients With DM. Arch Intern Med. 2012;172(17):1296–303.PubMed
28.
go back to reference Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159–219.PubMed Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159–219.PubMed
29.
go back to reference Argyrakopoulou G, Tsioufis C, Sdraka E, Tsiachris D, Makrilakis K, Stefanadis C. Antihypertensive treatment in diabetic patients. Rev Curr Data Maturitas. 2013;75(2):142–7. Argyrakopoulou G, Tsioufis C, Sdraka E, Tsiachris D, Makrilakis K, Stefanadis C. Antihypertensive treatment in diabetic patients. Rev Curr Data Maturitas. 2013;75(2):142–7.
30.
go back to reference Funnell MM, Anderson RM. The problem with compliance in diabetes. JAMA. 2000;284(13):1709.PubMed Funnell MM, Anderson RM. The problem with compliance in diabetes. JAMA. 2000;284(13):1709.PubMed
31.
go back to reference Nam S, Chesla C, Stotts NA, Kroon L, Janson SL. Barriers to diabetes management: patient and provider factors. Diabetes Res Clin Pract. 2011;93(1):1–9.PubMed Nam S, Chesla C, Stotts NA, Kroon L, Janson SL. Barriers to diabetes management: patient and provider factors. Diabetes Res Clin Pract. 2011;93(1):1–9.PubMed
32.
go back to reference Prugger C, Keil U, Wellmann J, De Bacquer D, de Backer G, Ambrosio GB, et al. Blood pressure control and knowledge of target blood pressure in coronary patients across Europe: results from the EUROASPIRE III survey. J Hypertens. 2011;29(8):1641–8.PubMed Prugger C, Keil U, Wellmann J, De Bacquer D, de Backer G, Ambrosio GB, et al. Blood pressure control and knowledge of target blood pressure in coronary patients across Europe: results from the EUROASPIRE III survey. J Hypertens. 2011;29(8):1641–8.PubMed
33.
go back to reference Wong ND, Lopez VA, L’Italien G, Chen R, Kline SEJ, Franklin SS. Inadequate control of hypertension in US adults with cardiovascular disease comorbidities in 2003–2004. Arch Intern Med. 2007;167(22):2431.PubMed Wong ND, Lopez VA, L’Italien G, Chen R, Kline SEJ, Franklin SS. Inadequate control of hypertension in US adults with cardiovascular disease comorbidities in 2003–2004. Arch Intern Med. 2007;167(22):2431.PubMed
34.
go back to reference Cholesterol Treatment Trialists' {CTT} Collaborators. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomized trials. The Lancet. 2010;376(9753):1670–81. Cholesterol Treatment Trialists' {CTT} Collaborators. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomized trials. The Lancet. 2010;376(9753):1670–81.
35.
go back to reference Masana L, Descamps O, Bosi E, Allaert F, Chapman M, Bruckert E. Lifestyle behavior and cardiovascular risk in hypercholesterolemia: impact of consumption of phytosterol-supplemented yogurt. Atheroscler Suppl. 2011;12(1):124. Masana L, Descamps O, Bosi E, Allaert F, Chapman M, Bruckert E. Lifestyle behavior and cardiovascular risk in hypercholesterolemia: impact of consumption of phytosterol-supplemented yogurt. Atheroscler Suppl. 2011;12(1):124.
36.
go back to reference De Berardis G, Sacco M, Strippoli GF, Pellegrini F, Graziano G, Tognoni G, et al. Aspirin for primary prevention of cardiovascular events in people with diabetes: meta-analysis of randomised controlled trials. Br Med J. 2009;339:b4531. De Berardis G, Sacco M, Strippoli GF, Pellegrini F, Graziano G, Tognoni G, et al. Aspirin for primary prevention of cardiovascular events in people with diabetes: meta-analysis of randomised controlled trials. Br Med J. 2009;339:b4531.
37.
go back to reference Skyler JS, Bergenstal R, Bonow RO, Buse J, Deedwania P, Gale EA, et al. Intensive Glycemic Control and the Prevention of Cardiovascular Events: Implications of the ACCORD, ADVANCE, and VA Diabetes TrialsA Position Statement of the American Diabetes Association and a Scientific Statement of the American College of Cardiology Foundation and the American Heart Association. J Am Coll Cardiol. 2009;53(3):298–304.PubMed Skyler JS, Bergenstal R, Bonow RO, Buse J, Deedwania P, Gale EA, et al. Intensive Glycemic Control and the Prevention of Cardiovascular Events: Implications of the ACCORD, ADVANCE, and VA Diabetes TrialsA Position Statement of the American Diabetes Association and a Scientific Statement of the American College of Cardiology Foundation and the American Heart Association. J Am Coll Cardiol. 2009;53(3):298–304.PubMed
38.
go back to reference Fu A, Ying Q, Larry R, Donald Y, Panagiotis M. Pre-existing cardiovascular diseases and glycemic control in patients with type 2 diabetes mellitus in Europe: a matched cohort study. Cardiovascular Diabetology. 2010. Online) doi:10.1186/1475-2840-9-15. (Accessed 2 August 2013. Fu A, Ying Q, Larry R, Donald Y, Panagiotis M. Pre-existing cardiovascular diseases and glycemic control in patients with type 2 diabetes mellitus in Europe: a matched cohort study. Cardiovascular Diabetology. 2010. Online) doi:10.1186/1475-2840-9-15. (Accessed 2 August 2013.
39.
go back to reference Anselmino M, Malmberg K, Öhrvik J, Rydén L. Evidence-based medication and revascularization: powerful tools in the management of patients with diabetes and coronary artery disease: a report from the Euro Heart Survey on diabetes and the heart. Eur J Cardiovasc Prev Rehabil. 2008;15(2):216–23.PubMed Anselmino M, Malmberg K, Öhrvik J, Rydén L. Evidence-based medication and revascularization: powerful tools in the management of patients with diabetes and coronary artery disease: a report from the Euro Heart Survey on diabetes and the heart. Eur J Cardiovasc Prev Rehabil. 2008;15(2):216–23.PubMed
40.
go back to reference Brookes ST, Whitely E, Egger M, Smith GD, Mulheran PA, Peters TJ. Subgroup analyses in randomized trials: risks of subgroup-specific analyses: power and sample size for the interaction test. J Clin Epidemiol. 2004;57(3):229–36.PubMed Brookes ST, Whitely E, Egger M, Smith GD, Mulheran PA, Peters TJ. Subgroup analyses in randomized trials: risks of subgroup-specific analyses: power and sample size for the interaction test. J Clin Epidemiol. 2004;57(3):229–36.PubMed
Metadata
Title
Comparison of treatment outcomes in patients with and without diabetes mellitus attending a multidisciplinary cardiovascular prevention programme (a retrospective analysis of the EUROACTION trial)
Authors
Sandra N Ofori
Kornelia Kotseva
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2015
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-015-0006-4

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