Comprehensive Cardiovascular Risk Factor Control Lacking in Diabetes
Improved interventions focused both on lifestyle management and evidence-based therapies that achieve all diabetes targets are necessary to optimize the prevention of future CVD.
Only 1 in 5 adults with diabetes achieved control over multiple risk factor targets for atherosclerotic cardiovascular disease (ASCVD), according to United States registry data published in Diabetes, Obesity and Metabolism.1
The Diabetes Collaborative Registry provides multidisciplinary data tracking diabetes and metabolic care through a collaboration of the American College of Cardiology, American Diabetes Association, American College of Physicians, American Association of Clinical Endocrinologists, and the Joslin Diabetes Center.
In this study, investigators examined Diabetes Collaborative Registry data from 74,393 patients with diabetes from 174 practices and 646 office locations. Of these patients, 88% were white, 41% were women, and the average age was 69. Patients' average body mass index was 32 kg/m2, almost 70% had prior ASCVD, and approximately 14% were current smokers.
Investigators found that 73.6% of patients met individual hemoglobin A1c targets, 69% met blood pressure targets, 48.6% met low-density lipoprotein cholesterol targets, and 85.2% were nonsmokers. However, only 21.6% of all patients achieved composite control of all 4 risk factors (P <.001). Overall risk factor control rates were lower in women (18.6%) compared with men (23.6%) and in patients who were black (14.7%), white (22.5%), and of other ethnicities (20.8%). Significant differences in rates were observed between patients with (20.7%) and without (23.6%) prior ASCVD.
The study investigators noted limitations to the Diabetes Collaborative Registry, including that the majority of data was collected from white patients and from a high number of cardiology practices, which may limit generalizability of the results to all patients with diabetes.
Pointing to studies suggesting a >50% lower risk for ASCVD in patients with diabetes who achieved multiple risk factor targets,2,3 the investigators stated that "[i]mproved multifactorial interventions focused both on lifestyle management and evidence-based therapies to achieve all targets will be necessary to optimize the prevention of future [cardiovascular disease]."
1. Fan W, Song Y, Inzucchi SE, et al. Composite cardiovascular risk factor target achievement and its predictors in US adults with diabetes: The Diabetes Collaborative Registry [published online January 4, 2019]. Diabetes Obes Metab. doi:10.1111/dom.13625
2. Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;348(5):383-393.
3. Wong ND, Zhao Y, Patel R, et al. 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;39(5):668-676.