Preventable major cardiovascular events associated with uncontrolled glucose, blood pressure, and lipids and active smoking in adults with diabetes with and without cardiovascular disease: a contemporary analysis

Diabetes Care. 2015 May;38(5):905-12. doi: 10.2337/dc14-1877. Epub 2015 Feb 20.

Abstract

Objective: The objective of this study was to assess 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.

Research design and methods: 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.

Results: 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.

Conclusions: Additional attention to traditional CV risk factors could yield further substantive reductions in CV events and mortality in adults with diabetes.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Glucose / metabolism
  • Blood Pressure / physiology
  • Blood Pressure Determination
  • Cause of Death
  • Cholesterol, LDL / blood
  • Diabetes Mellitus, Type 1 / mortality
  • Diabetes Mellitus, Type 1 / physiopathology
  • Diabetes Mellitus, Type 1 / prevention & control*
  • Diabetes Mellitus, Type 2 / mortality
  • Diabetes Mellitus, Type 2 / physiopathology
  • Diabetes Mellitus, Type 2 / prevention & control*
  • Diabetic Angiopathies / mortality
  • Diabetic Angiopathies / physiopathology
  • Diabetic Angiopathies / prevention & control*
  • Female
  • Glycated Hemoglobin A / metabolism
  • Heart Failure / mortality
  • Hospitalization / statistics & numerical data
  • Humans
  • Hypertension / complications
  • Incidence
  • Male
  • Middle Aged
  • Myocardial Infarction / mortality
  • Risk Factors
  • Smoking / adverse effects*
  • Smoking / mortality
  • Stroke / mortality
  • United States
  • Young Adult

Substances

  • Blood Glucose
  • Cholesterol, LDL
  • Glycated Hemoglobin A