Dysglycaemia and cardiovascular disease. Aspects on screening, management, and prognosis

Background: Dysglycaemia, in this thesis defined as impaired glucose tolerance (IGT) or type 2 diabetes (T2DM), is a major risk factor for cardiovascular disease (CVD). International guidelines recommend screening for dysglycaemia and target-driven lifestyle and pharmacological management in people with high cardiovascular (CV) risk or established CVD for both men and women. New glucose-lowering drugs with proven CV benefit are now available. Aims: The overall aim of this doctoral thesis was to investigate the screening and management of patients with CVD or at high CV risk including gender differences and implementation of new cardioprotective glucose-lowering drugs by studying: - the prevalence of dysglycaemia according to different screening tools in patients without known diabetes (Study I) and by gender (Study II); - the value of new screening methods for dysglycaemia in these patients (Study III and IV); - the management of such patients as regards lifestyle habits, use of cardioprotective drugs, and treatment target attainment (Study I) including possible gender disparities (Study II); - gender differences in prognosis (Study II); - whether cardioprotection of the glucagon-like peptide-1 receptor agonist dulaglutide is dependent on metformin (Study V). Methods: Studies I, II, III and IV were based on the population from the EUROASPIRE V cross-sectional survey; Study II included data from EUROASPIRE IV and V. Both surveys included patients with established coronary artery disease recruited across Europe at least six months prior to the investigation. Data on clinical history, life-style advice and pharmacological treatment was based on validated questionnaires and standardised blood tests at a study visit. Study V is based on patients with T2DM at high CV risk from the randomised controlled trial REWIND. Results: Prevalence and screening for dysglycaemia: In Study I, 29% of the study population had dysglycaemia detected by screening, with 70% of them being ide