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09-04-2014 | Cardiology | Article

Aggressive risk factor control could prevent large proportion of CHD in Type 2 diabetes


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medwireNews: Aggressive management of multiple known risk factors could prevent over half of coronary heart disease (CHD) events in US men and women with Type 2 diabetes, report researchers.

Their findings indicate that even controlling these risk factors – smoking, high- and low-density lipoprotein cholesterol (H/LDL-C) levels, glycated haemoglobin (HbA1c) levels and systolic blood pressure – to minimum goal levels could result in the prevention of 35% and 45% of CHD events in men and women with Type 2 diabetes, respectively.

“Importantly, although overall half of US persons with diabetes have been recently shown to achieve individual targets for LDL-C, blood pressure, and HbA1c, achievement of goal for the composite of these 3 targets is seen in only 1/4 of patients,” say Nathan Wong (University of California, Irvine, USA) and colleagues.

The team estimated the impact of achieving control over CHD risk factors in 1209 US individuals aged at least 30 years with Type 2 diabetes, according to three risk factor models. CHD projections were based on data from the United Kingdom Prospective Diabetes Study Risk Engine.

In the first model, if current smokers became past smokers and individuals achieved minimum goal levels for all other risk factors (based on American Diabetes Association guidelines, including HbA1c >7% and systolic blood pressure <130 mm/Hg), the 10-year CHD risk would fall from 16.5% to 10.2%, equating to an overall estimated 38.3% of CHD events prevented, write Wong et al in the American Journal of Cardiology.

A stricter model of “nominal” risk factor control where, in addition to controlling for smoking, patient data were controlled to reflect a 1% absolute reduction in HbA1c levels (7.6 mmol/mol), a 10% reduction in systolic blood pressure, a 10% relative increase in HDL-C and a 25% relative reduction in total cholesterol, resulted in a 10-year CHD risk of 10.4%, or 36.7% of events prevented.

The final and most aggressive model of risk factor control doubled the requirements of the “nominal” model, and predicted a 7.5% risk of CHD, or 54.8% of events prevented, over 10 years for Type 2 diabetes patients.

While control of total cholesterol (a 50% relative reduction) resulted in the greatest effect on CHD risk, preventing 35.1% of events, the largest reduction in CHD events overall was predicted for women younger than 45 years, at 71.6%.

The authors hope that their results will motivate clinicians to stress the importance of “multifactorial composite risk factor control” to their patients with Type 2 diabetes.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2014

By Sarah Pritchard, medwireNews Reporter

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