Glycemic control low priority in diabetes CVD prevention

By Sally Robertson, B.Sc.Feb 4 2013

Maintaining glycemic control does not reduce the likelihood for cardiovascular disease (CVD) leading to hospitalization in people with Type 2 diabetes, report US researchers.

On the other hand, keeping systolic blood pressure (SBP) and low-density lipoprotein (LDL) cholesterol levels in check does significantly reduce their risk for CVD hospitalization, say Gregory Nichols (Kaiser Permanente Center for Health Research, Portland, Oregon, USA) and colleagues.

"Our findings will likely contribute to the emerging controversy over optimal A1C [glycated hemoglobin; HbA1c] levels," writes the team in the Journal of General Internal Medicine. "Despite guidelines recommending multi-factorial treatment of cardiometabolic risk factors, there are surprisingly few studies that have examined the simultaneous benefits of risk factor control."

Nichols and team report that in their study of 26,636 patients diagnosed with Type 2 diabetes, 1943 (7.3%) individuals were hospitalized due to CVD over a mean of 5.6 years.

During this follow up, the HbA1c levels did not differ between those who had a CVD hospitalization and those who did not. However, mean SBP and LDL cholesterol levels were significantly greater among those who were hospitalized due to CVD.

Similarly, the proportion of patients who maintained control of their HbA1c, defined as a level below 7%, did not differ between those who experienced a CVD hospitalization and those who did not (47.2 vs 45.6%), whereas the proportion with controlled SBP (<130 mmHg) or controlled LDL cholesterol (<100 mg/dL) was significantly lower among those who had a CVD hospitalization, at 27.9% versus 44.1% and 51.9% versus 59.5%, respectively.

Patients who had no risk factors or only HbA1c controlled had the highest CVD hospitalization rates, at 21.0% and 15.4%, respectively, whereas those with all three risk factors or both SBP and LDL cholesterol controlled had the lowest rates, at 9.2% and 7.1%, respectively.

Furthermore, rates of CVD hospitalization were similar among those who only had controlled SBP or LDL cholesterol, or in whom one of these risk factors and HbA1c were controlled, and were significantly lower than in those with no controlled risk factors or only controlled HbA1c, but significantly higher than in those with control of all three risk factors or both SBP and LDL cholesterol.

"To our knowledge, the current study is the first to simultaneously evaluate the contribution of all possible combinations of A1C, SBP, and [LDL cholesterol] control to CVD risk reduction," says the team.

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