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25-09-2011 | Diabetes | Article

Diabetic ethnic minorities have poorer CVD risk factor control


Free abstract

MedWire News: White individuals with diabetes are more likely to have cardiovascular risk factor control compared with people from ethnic minorities with diabetes, research shows.

On the whole, cardiovascular risk factor control needs to improve in all diabetes patients, say researchers, but especially among ethnic minorities.

In the journal Diabetes Research and Clinical Practice, Leonard Egede (Medical University of South Carolina, Charleston, USA) and colleagues point out that diabetes patients often have other comorbid conditions, including hypertension and high cholesterol levels.

Despite these risk factors, they are often not treated to diabetes-specific guidelines for blood pressure and cholesterol.

In the USA, individuals who use the Veterans Affairs (VA) healthcare system are typically older and have a higher prevalence of cardiovascular risk factors than the general population. Veterans with diabetes usually have poorer cardiovascular risk factor control than individuals outside the VA system.

The present study, which included a cohort of 11,203 US veterans with Type 2 diabetes, examined longitudinal differences in multiple cardiovascular risk factor control by ethnicity.

Compared with non-Hispanic White VA patients with diabetes, non-Hispanic Black patients were two times more likely to have at least one out of control cardiovascular risk factor - glycated hemoglobin (>7%), blood pressure (systolic >130 mmgHg, diastolic >80 mmHg), or low-density lipoprotein (>100 mg/dl) cholesterol levels (odds ratio [OR]=2.02).

Hispanic people with diabetes in the VA system also had a greater risk of having at least one cardiovascular risk factor not treated to target compared with non-Hispanic White people (OR=1.48).

Furthermore, the odds of having all three cardiovascular risk factors above treatment goals over time was significantly higher in non-Hispanic Black and Hispanic diabetes patients compared with White patients (OR=7.66 and 4.06, respectively).

Interestingly, individuals with coronary heart disease, congestive heart failure, or a psychotic disorder were significantly less likely to have out of control cardiovascular risk factors than those without these conditions (OR=0.63, 0.68, and 0.61, respectively). Investigators attribute the improved control to their increased access to the VA healthcare system.

Veterans who were never married, or those who were divorced, were also more likely to have at least one cardiovascular risk factor not treated to goal than patients who were married (OR=1.38 and 1.16, respectively).

In their paper, Egede and colleagues point out that diabetes patients require an extensive, multipronged approach to cardiovascular risk factor control.

"Further studies are needed to identify explanatory factors and test effective behavioral and clinical interventions for aggressive multiple cardiovascular disease risk control in adults with Type 2 diabetes," they write.

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