Controlling factors such as HbA1c, LDL cholesterol, blood pressure, and smoking can all help to reduce risk…
Researchers assessed the incidence of major cardiovascular (CV) hospitalization events and all-cause deaths among adults with diabetes with or without CV disease (CVD) associated with inadequately controlled glycated hemoglobin (A1C), high LDL cholesterol (LDL-C), high blood pressure (BP), and current smoking.
Study subjects included 859,617 adults with diabetes enrolled for more than 6 months during 2005-2011 in a network of 11 U.S. integrated health care organizations. Inadequate risk factor control was classified as LDL-C ≥100 mg/dL, A1C ≥7% (53 mmol/mol), BP ≥140/90 mm Hg, or smoking. Major CV events were based on primary hospital discharge diagnoses for myocardial infarction (MI) and acute coronary syndrome (ACS), stroke, or heart failure (HF). Five-year incidence rates, rate ratios, and average attributable fractions were estimated using multivariable Poisson regression models.
Mean (SD) age at baseline was 59 (14) years; 48% of subjects were female, 45% were white, and 31% had CVD. Mean follow-up was 59 months. Event rates per 100 person-years for adults with diabetes and CVD versus those without CVD were 6.0 vs. 1.7 for MI/ACS, 5.3 vs. 1.5 for stroke, 8.4 vs. 1.2 for HF, 18.1 vs. 40 for all CV events, and 23.5 vs. 5.0 for all-cause mortality. The percentages of CV events and deaths associated with inadequate risk factor control were 11% and 3%, respectively, for those with CVD and 34% and 7%, respectively, for those without CVD.
Additional attention to traditional CV risk factors could yield further substantive reductions in CV events and mortality in adults with diabetes.
- This study assessed the contribution of specific risk factors for major cardiovascular (CV) hospitalization events and all-cause mortality in 859,617 individuals with diabetes with and without baseline CV disease.
- Risk factors associated with CV disease that were examined included glucose levels, blood pressure, lipids, and active smoking. Event rates for stroke, heart failure, all-cause mortality, and myocardial infarction and acute coronary syndrome were higher in those with CV disease than in those without.
- The percentages of CV events and deaths associated with inadequate control of risk factors were higher in those with CV disease than without.
Diabetes Care 2015 Feb 20, G Vazquez-Benitez, JR Desai, S Xu