Considerably decreased risk of cardiovascular disease with combined reductions in HbA1c, blood pressure and blood lipids in type 2 diabetes: Report from the Swedish National Diabetes Register

Diab Vasc Dis Res. 2016 Jul;13(4):268-77. doi: 10.1177/1479164116637311. Epub 2016 Apr 21.

Abstract

Objectives: Assess the effect of risk factors changes on risk for cardiovascular disease and mortality in patients with type 2 diabetes selected from the Swedish National Diabetes Register.

Methods: Observational study of 13,477 females and males aged 30-75 years, with baseline HbA1c 41-67 mmol/mol, systolic blood pressure 122-154 mmHg and ratio non-HDL:HDL 1.7-4.1, followed for mean 6.5 years until 2012. Four groups were created: a reference group (n = 6757) with increasing final versus baseline HbA1c, systolic blood pressure and non-HDL:HDL cholesterol during the study period, and three groups with decreasing HbA1c (n = 1925), HbA1c and systolic blood pressure (n = 2050) or HbA1c and systolic blood pressure and non-HDL:HDL (n = 2745).

Results: Relative risk reduction for fatal/nonfatal cardiovascular disease was 35% with decrease in HbA1c only (mean 6 to final 49 mmol/mol), 56% with decrease in HbA1c and systolic blood pressure (mean 12 to final 128 mmHg) and 75% with combined decreases in HbA1c, systolic blood pressure and non-HDL:HDL (mean 0.8 to final 2.1), all p < 0.001 adjusting for clinical characteristics, other risk factors, treatments and previous cardiovascular disease. Similar risk reductions were found for fatal/nonfatal coronary heart disease, fatal cardiovascular disease, all-cause mortality and also in a subgroup of 3038 patients with albuminuria.

Conclusion: Considerable risk reductions for cardiovascular disease and mortality were seen with combined long-term risk factor improvement.

Keywords: Blood lipids; HbA1c; blood pressure; cardiovascular diseases; diabetes mellitus.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • Blood Pressure*
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / prevention & control*
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / mortality
  • Diabetes Mellitus, Type 2 / therapy*
  • Dyslipidemias / blood
  • Dyslipidemias / diagnosis
  • Dyslipidemias / mortality
  • Dyslipidemias / therapy*
  • Female
  • Glycated Hemoglobin A / metabolism*
  • Humans
  • Hypertension / diagnosis
  • Hypertension / mortality
  • Hypertension / physiopathology
  • Hypertension / therapy*
  • Incidence
  • Kaplan-Meier Estimate
  • Lipids / blood*
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Propensity Score
  • Prospective Studies
  • Registries
  • Risk Assessment
  • Risk Factors
  • Sweden / epidemiology
  • Time Factors

Substances

  • Biomarkers
  • Glycated Hemoglobin A
  • Lipids
  • hemoglobin A1c protein, human