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Issue 91 Item 11 Cardiovascular Risk Factors Are Poorly Controlled in People wit

Study shows a failure to achieve goals in reducing risk factors for CVD unless diabetes education is part of treatment plan!  

A recent prospective observa­tional study of 235 patients being treated for type 2 diabetes showed a failure to achieve goals for many modifiable risk factors of cardiovascular disease, Including HbA1~ concentration, LDL-C and HDL-C values, blood pressure (BP) level, and body mass Index (BMI). In fact, optimal control of all modifiable risk Factors was found in only one patient.
 
The patients had been referred for elective cardiac catheterization (81% had documented coronary artery disease at baseline) over slightly more than a 2-year period.  

Using guidelines published by the American Diabetes Association and the National institutes of Health, the investigators compared findings in the study population with goals that included the following: HbA1c <7%; LDL-C <100 mg/dL; HDL-C _45 mg/dL for men, _55 mg/dL for women; triglycerides <200 mg/dL; BP <130/85 mmHg; and BMI <25. 

Among the results: Only 21% of patients met the HbA1c goal, and only 52% met that for LDL-C. Even worse, optimal HDL-C levels were achieved in only 22% of men and 18% of women. Worst of all, the proportion of patients with the recommended DP value was just 10%, that with the recommended BMI 11%. On the other hand, 76% of patients met the triglyc­erides goal. 

About half of the patients were taking oral hypoglycemics and half insulin. In addition, 47% were on lipid-lowering therapy, 40% were taking an ACE inhibitor, 54% a fl-blocker, and 82% aspirin. 

Acknowledging that the sample size was small, but noting that It was derived from a very broad patient base, the investigators concluded that their findings may highlight major deficiencies in cardiovascular risk Factor modification in the US population with diabetes as a whole. Of particular concern was the poor glycemic control, inadequate BP management! and suboptimal lipid treatment, given current standards of diabetes care emphasizing the need for aggressive treatment in each of those respects. 

The investigators speculated that such under-treatment may be brought about in part by the numer­ous medications that patients with diabetes are expected to take each day. An aggressive, yet realistic treatment plan, combined with diabetes education, would not only promote patient compliance with an aggressive management scheme but would also contribute to the scheme’s effectiveness. 

Qeorga PB at ci. Treetment of cardiac risk factors In diabetic patients:How well do we follow the guidelines? Am Heart J. 2001;142:B57-883