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. 2010 Aug;56(8):e302-7.

Cardiovascular disease in type 2 diabetes: Attributable risk due to modifiable risk factors

John Zeber  1 , Michael L Parchman
Affiliations

Cardiovascular disease in type 2 diabetes: Attributable risk due to modifiable risk factors

John Zeber et al. Can Fam Physician. 2010 Aug.

Abstract
in English, French

Objective: To examine the common clinical and behavioural factors that contribute to cardiovascular disease (CVD) risk (ie, attributable risk) among those with type 2 diabetes.

Design: Analysis of data from a larger observational study. Using the validated UK Prospective Diabetes Study risk engine, the primary analysis examined the prevalence and attributable risk of CVD for 4 factors. Multivariable models also examined the association between attributable CVD risk and appropriate self-management behaviour.

Setting: Twenty primary health care clinics in the South Texas area of the United States.

Participants: A total of 313 patients with type 2 diabetes mellitus currently receiving primary care services for their condition.

Main outcome measures: Prevalence of elevated CVD risk factors (glycated hemoglobin [HbA(1c)] levels, blood pressure, lipid levels, and smoking status), the attributable risk owing to these factors, and the association between attributable risk of CVD and diet, exercise, and medication adherence.

Results: The mean 10-year CVD risk for the study population (N = 313) was 16.2%, with a range of 6.5% to 48.5% across clinics; nearly one-third of this total risk was attributable to modifiable factors. The primary variable driving risk reduction was HbA(1c) levels, followed by smoking status and lipid levels. Patients who were carefully engaged in monitoring their diets and medications reduced their CVD risk by 44% and 39%, respectively (P < .03).

Conclusion: Patients with diabetes experience a substantial risk of CVD owing to potentially modifiable behavioural factors. High-quality diabetes care requires targeting modifiable patient factors strongly associated with CVD risk, including self-management behaviour such as diet and medication adherence, to better tailor clinical interventions and improve the health status of individuals with this chronic condition.

OBJECTIF: Examiner les facteurs cliniques et comportementaux courants qui contribuent aux maladies cardiovasculaires (MCV) (c.-à-d. le risque attribuable) chez les personnes atteintes du diabète de type 2.

TYPE D’ÉTUDE: Analyse des données tirées d’une importante étude observationnelle. À l’aide de l’instrument validé de mesure du risque d’une étude prospective sur le diabète au Royaume-Uni, l’analyse primaire examinait l’association entre le risque attribuable de MCV et un comportement approprié dans la prise en charge de leur santé par les intéressés.

CONTEXTE: Vingt cliniques médicales de soins primaires dans la région du sud du Texas, aux États-Unis.

PARTICIPANTS: Total de 313 patients ayant un diabète de type 2 et recevant actuellement des services de soins primaires pour ce problème de santé.

PRINCIPAUX PARAMÈTRES ÉTUDIÉS: Prévalence des facteurs de risque élevé de MCV (taux d’hémoglobine glycolisée [HbA1c], tension artérielle, taux de lipides et tabagisme), risque attribuable en raison de ces facteurs, et association entre le risque attribuable de MCV et l’alimentation, l’activité physique et la conformité à la médication prescrite.

RÉSULTATS: Le risque médian sur 10 ans de MCV dans la population à l’étude (N = 313) était de 16,2 %, le taux variant de 6,5 % à 48,5 % selon la clinique; près du tiers de ce risque total était attribuable à des facteurs modifiables. La principale variable pouvant amener une réduction du risque était les taux de HbA1c, suivis du tabagisme et des taux de lipides. Les patients qui surveillaient attentivement leur alimentation et leur médicaments pouvaient réduire leur risque de MCV de 44 % et 39 % respectivement (P < ,03).

CONCLUSION: Les patients diabétiques courent un risque considérable de MCV en raison de facteurs comportementaux qu’il est possible de modifier. Des soins de grande qualité pour le diabète exigent de cibler chez les patients les facteurs modifiables fortement associés au risque de MCV, y compris les comportements dans la prise en charge de leur santé comme le respect du régime alimentaire et des médicaments prescrits, pour mieux adapter sur mesure les interventions cliniques et améliorer l’état de santé des personnes souffrant de cette maladie chronique.

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Figures

Figure 1.
Figure 1.
Cardiovascular disease and attributable risk factors, by clinic BP—blood pressue, CVD—cardiovascular disease, HbA1c—glycated hemoglobin, HDL-C—high density lipoprotein cholesterol.
See this image and copyright information in PMC

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