medwireNews: The risk for cardiovascular disease (CVD) is at least one-fifth higher in people with type 2 diabetes than in those without diabetes, even when risk factors are optimally controlled, study findings indicate.
The retrospective study included data for 101,749 people with type 2 diabetes and 378,938 matched non-diabetic controls from the English Clinical Practice Research Datalink (CPRD) GOLD database along with 330,892 people with type 2 diabetes from the Scottish Care Information (SCI)-Diabetes dataset.
The researchers report in Circulation that, during 3 years of follow-up, CVD events occurred in 27% of people with diabetes and 19% of controls from the CPRD cohort. The rate was 31% during 6 years of follow-up in the SCI-Diabetes group.
The proportions with suboptimal risk factor control varied among the three groups but ranged from 17% to 20% for smoking, 42–68% for raised total cholesterol (>4 mmol/L), 12–42% for raised triglycerides (>1.7 mmol/L) and 15–21% for raised blood pressure (>140/80 mmHg or >130/80 mmHg if high risk).
In the participants with diabetes, glycated hemoglobin levels were elevated (>7.0% or 53 mmol/mol) in approximately half of cases and notably, only 6% of people with diabetes had optimal risk factor control, Wright et al remark.
After adjustment for potential confounders, the investigators found that the risk for CVD events (fatal/nonfatal coronary heart disease, stroke, or heart failure hospitalization) was a significant 32% higher in the people with diabetes versus those without.
When the analysis was restricted to people with optimal control of all five risk factors, the CV event risk was still a significant 21% higher with versus without diabetes and the risk increased with increasing numbers of uncontrolled risk factors, to a significant 115% in people who had suboptimal control across all five variables.
Approximately one-third of participants with type 2 diabetes across the two cohorts also had cardiorenal disease, indicating high CV risk. Analysis of data for these individuals revealed only a weak association between the number of suboptimal risk factors and risk for CVD events, with a significant hazard ratio (HR) of 1.09 for people with five uncontrolled risk factors versus those with optimal control.
By comparison, the risk increased in a stepwise fashion with each additional suboptimal risk factor among the people with type 2 diabetes and no cardiorenal disease, reaching a significant HR of 1.96 when five risk factors were elevated.
The researchers conclude: “Our observational data suggest that in people with [type 2 diabetes] there is a clinically significant residual CVD risk even when all causal risk factors are optimally managed, at least to levels mandated in the United Kingdom by the National Institute for Health and Care Excellence.”
They add: “Since overall risk factor management was poor, we encourage greater use of guideline-driven care, newer agents including SGLT2 [inhibitors] and GLP-1 [receptor agonists], pharmacist-led clinics, IT systems supporting self-management, and clinical decision to support for clinical staff.”
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