Cardiovascular Risk Factor Targets and Cardiovascular Disease Event Risk in Diabetes: A Pooling Project of the Atherosclerosis Risk in Communities Study, Multi-Ethnic Study of Atherosclerosis, and Jackson Heart Study.

Pubmed ID: 27208374

Pubmed Central ID: PMC4839178

Journal: Diabetes care

Publication Date: May 1, 2016

MeSH Terms: Humans, Male, Adult, Female, Aged, Aged, 80 and over, Cardiovascular Diseases, Risk Factors, United States, Cohort Studies, Middle Aged, Proportional Hazards Models, Blood Pressure, Follow-Up Studies, Incidence, Cholesterol, HDL, Diabetes Mellitus, Type 2, Cholesterol, LDL, Ethnicity, Glycated Hemoglobin

Grants: HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, HHSN268201100012C, K24 DK106414, UL1 RR025005, HHSN268201300049C, HHSN268201300048C, HHSN268201300047C, HHSN268201300050C, HHSN268201300046C, N01HC95163, N01HC95161, N01HC95167, N01HC95159, N01HC95162, N01HC95166, N01HC95169, N01HC95165, N01HC95164, N01HC95160, UL1 TR000040, N01HC95168, HHSN268201100009I, HHSN268201100005G, HHSN268201100008I, HHSN268201100011I, HHSN268201100005I, HHSN268201100007I, R01 HL117285, R01 HL128801

Authors: Bertoni AG, Folsom AR, Zhao Y, Taylor H, Selvin E, Correa A, Wong ND, Patel R, Patao C, Malik S, Kachroo S, Mukherjee J

Cite As: Wong ND, Zhao Y, Patel R, Patao C, Malik S, Bertoni AG, Correa A, Folsom AR, Kachroo S, Mukherjee J, Taylor H, Selvin E. Cardiovascular Risk Factor Targets and Cardiovascular Disease Event Risk in Diabetes: A Pooling Project of the Atherosclerosis Risk in Communities Study, Multi-Ethnic Study of Atherosclerosis, and Jackson Heart Study. Diabetes Care 2016 May;39(5):668-76. Epub 2016 Mar 29.

Studies:

Abstract

OBJECTIVE: Controlling cardiovascular disease (CVD) risk factors in diabetes mellitus (DM) reduces the number of CVD events, but the effects of multifactorial risk factor control are not well quantified. We examined whether being at targets for blood pressure (BP), LDL cholesterol (LDL-C), and glycated hemoglobin (HbA1c) together are associated with lower risks for CVD events in U.S. adults with DM. RESEARCH DESIGN AND METHODS: We studied 2,018 adults, 28-86 years of age with DM but without known CVD, from the Atherosclerosis Risk in Communities (ARIC) study, Multi-Ethnic Study of Atherosclerosis (MESA), and Jackson Heart Study (JHS). Cox regression examined coronary heart disease (CHD) and CVD events over a mean 11-year follow-up in those individuals at BP, LDL-C, and HbA1c target levels, and by the number of controlled risk factors. RESULTS: Of 2,018 DM subjects (43% male, 55% African American), 41.8%, 32.1%, and 41.9% were at target levels for BP, LDL-C, and HbA1c, respectively; 41.1%, 26.5%, and 7.2% were at target levels for any one, two, or all three factors, respectively. Being at BP, LDL-C, or HbA1c target levels related to 17%, 33%, and 37% lower CVD risks and 17%, 41%, and 36% lower CHD risks, respectively (P < 0.05 to P < 0.0001, except for BP in CHD risk); those subjects with one, two, or all three risk factors at target levels (vs. none) had incrementally lower adjusted risks of CVD events of 36%, 52%, and 62%, respectively, and incrementally lower adjusted risks of CHD events of 41%, 56%, and 60%, respectively (P < 0.001 to P < 0.0001). Propensity score adjustment showed similar findings. CONCLUSIONS: Optimal levels of BP, LDL-C, and HbA1c occurring together in individuals with DM are uncommon, but are associated with substantially lower risk of CHD and CVD.