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Which Is More Important: Blood Sugar, Blood Pressure or Cholesterol Targets?

For people with diabetes, meeting the recommended guidelines for blood pressure and cholesterol is….

For people with diabetes, meeting the recommended guidelines for blood pressure and cholesterol is even more important than meeting the guidelines for blood sugar control in reducing the risk of heart attack or stroke, according to a new study.

The study included more than 26,000 patients with diabetes. Patients who met guidelines for all three risk factors and those who met the blood pressure and cholesterol guidelines were least likely to be hospitalized for a heart attack or stroke. Those who met none of the guidelines and those who met only the blood sugar guidelines were most likely to be hospitalized for a heart attack or stroke.

Greg Nichols, Ph.D., lead author of the study and senior investigator with the Kaiser Permanente Center for Health Research stated that, "People with diabetes are often focused on controlling their blood sugar, but our study found that controlling blood pressure and cholesterol is even more important in preventing heart disease." "This doesn’t mean that people with diabetes should ignore their blood sugar levels. They should still get regular A1C tests to measure and control their blood glucose, but it’s also important to pay attention to other factors that increase the risk for cardiovascular disease."

Adults with diabetes are two to four times more likely than people without diabetes to have cardiovascular disease, and most people with diabetes will die from a heart attack or stroke, according to the U.S. Department of Health and Human Services. There is abundant evidence that controlling the ABCs – A1C, blood pressure, and cholesterol – can reduce the risk, but until now it has been unclear which of these factors is most important.

The American Diabetes Association recommends that patients with diabetes maintain a target blood pressure reading of less than 130/80 mm Hg, an LDL cholesterol level of less than 100 mg/dl, and an A1C blood glucose level of less than 7 percent.

For this study, researchers examined the medical records of 26,636 adult patients from the Kaiser Permanente diabetes registry in Oregon and Washington starting in 2002 and following the patients through 2010, or until they died, left the health plan, or were hospitalized for a cardiovascular event such as a heart attack. Patients who were included had to have measurements of blood pressure, cholesterol, and A1C no more than six months apart, and researchers used the mean of those measurements if they were taken several times throughout the study period.

Most previous studies have examined one or two of these risk factors, but not all three at the same time. This is the first time researchers have published results of a study examining the risk factors simultaneously, and reporting the individual contribution of each factor on diabetes-related heart disease. About 13 percent of patients in the study met targets for all three risk factors. Their rate of hospitalization for heart attack and stroke was about 2.5 times lower than the patients who met none of the targets. Patients were followed for an average of six years, and during that time 7 percent of the patients were hospitalized for a cardiovascular event.

General Internal Medicine, Jan. 2013