Thursday , October 19 2017
Home / Resources / Articles / Preventing Major Cardiovascular Events in Diabetics

Preventing Major Cardiovascular Events in Diabetics

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.

Practice Pearls:

  • 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