(P040) RESIDUAL CARDIOVASCULAR RISK WITHIN INDIGENOUS PATIENTS: ASSOCIATIONS BETWEEN DIABETES AND ALL-CAUSE MORTALITY FOLLOWING AN ACUTE CORONARY SYNDROME

Background: Diabetes differentially confers significant residual cardiovascular risk in Indigenous compared with non-Indigenous patients. With advances in diabetes care, and strategies aimed at mitigating diabetes-related cardiovascular risk specifically within Indigenous patients, limited contemporary information exists on the relationship between diabetes and all-cause mortality following an acute coronary syndrome (ACS) in Indigenous patients.

METHODS AND RESULTS: In self-identified Indigenous patients consecutively admitted for an ACS (STEMI and NSTEMI/UA, respectively) at the Royal University Hospital, Saskatoon, we compared between Indigenous patients with and without diabetes, their demographics, treatments and all-cause mortality (in-hospital and 3-years). All comparisons are made between diabetes and non-diabetes respectively.

Of the 477 Indigenous ACS patients, 256 (53.7%) had diabetes; these patients were more likely to have had established coronary artery disease/prior coronary revascularization, polyvascular arterial disease, chronic kidney disease, present in heart failure and had higher admitting levels of serum creatinine and triglyceride levels. No significant differences in presenting ACS subtypes, ischemic times and revascularization strategies were noted between the two groups. No significant in-hospital mortality differences were observed for either STEMI (7.4% vs. 9.4%, p=0.64) or NSTEMI/UA (2.3% vs. 1.5%, p=0.70), however, significantly higher all-cause mortality was evident through 3 years of follow up (13.3% vs. 6.8%, p=0.02).

Conclusion: Diabetes was prevalent in half of all ACS admissions within Indigenous patients and associated significantly with prognostic diabetes-related comorbidites. A nearly two-fold higher all-cause mortality over 3 years is evident within Indigenous patients with diabetes compared to those without diabetes. These findings highlight the need for multi-pronged, culturally aligned, community-level primary and secondary risk reduction strategies aimed at mitigating diabetes-related vascular risk.