NEW YORK (Reuters Health) - Every year, approximately 6% of diabetic patients with a prior cardiovascular disease (CVD) event develop a recurrent major CVD complication, according to findings published in the November issue of Diabetes Care.

"Preventing relapses of CVD in patients with previous CVD is a daunting task for clinicians," Dr. Carlo B. Giorda, of Regione Piemonte, Chieri, Italy, and colleagues write.

The researchers studied type 2 diabetic patients receiving standard care at a network of diabetes clinics. They conducted separate analyses of 2788 patients with CVD at baseline (cohort A) and 844 patients who developed the first episode during the observation period (cohort B).

During 4 years of follow-up, 414 patients from cohort A and 54 from cohort B developed at least one recurrent event. The age-adjusted incidence rate of a recurrent event (per 1000 person-years) in cohort A was 72.7 in men and 32.5 in women. In cohort B, the incidence rate of a recurrent event was 40.1 in men and 22.4 in women.

On multivariate analysis, age, male gender, and use of insulin (alone or in combination with oral agents) independently predicted recurrence in cohort A.

In cohort B, serum triglyceride level of at least 1.69 mmol/L was the only metabolic factor to independently predict risk.

The strongest predictor of recurrent CVD in both cohorts was a prior CVD episode, especially myocardial infarction.

These results have significant clinical implications, the authors say. "First, diabetic patients, especially elderly men, whose CVD onset is myocardial infarction or revascularization (or combined events) warrant close follow-up and intensive management," they explain. "Second, patients using insulin show a higher frequency of recurrent events," they note. "Third, diabetic patients with high triglycerides levels may be targeted by aggressive treatment in secondary CVD prevention."