Patients with type 2 diabetes and all risk factors controlled still have increased CVD risk
Risk factor control was more strongly associated with mortality risk among patients with cardiorenal disease than those without, according to a retrospective British study.
Patients with well-controlled type 2 diabetes have a 21% higher cardiovascular disease (CVD) risk than patients without diabetes, a study found.
To examine the association between risk factor control and CVD risk in type 2 diabetes, as well as assess whether cardiorenal disease affects risk, researchers conducted a retrospective cohort study using two British datasets, England's CPRD (Clinical Practice Research Datalink) and Scotland's SCI-Diabetes dataset (Scottish Care Information-Diabetes). Patients with diabetes were categorized into six groups, defined by the number of baseline risk factors above clinically optimal levels: current smoker, total cholesterol level above 4 mmol/L, triglycerides level above 1.7 mmol/L, HbA1c level of 7.0% or greater, and systolic blood pressure above 140 mm Hg or above 130 mm Hg in the presence of renal impairment, retinopathy, or cerebrovascular disease. There were 101,749 patients with type 2 diabetes in CPRD matched with 378,938 controls without diabetes and 330,892 with type 2 diabetes in SCI-Diabetes. Results were published Nov. 16 by Circulation.
The CPRD offered three years of follow-up, and the SCI-Diabetes offered six years. During those time frames, CVD events occurred among 27,900 (27%) patients with diabetes in the CPRD dataset, 101,362 (31%) patients with diabetes in SCI-Diabetes, and 75,520 (19%) CPRD controls. In CPRD, type 2 diabetes participants with all risk factors controlled had a higher risk of CVD events (adjusted hazard ratio, 1.21; 95% CI, 1.12 to 1.29) than controls. For the following pooled analysis, patients were said to have cardiorenal disease if they had a history of acute myocardial infarction, stroke, coronary heart disease, or renal impairment. In type 2 diabetes participants from CPRD and SCI-Diabetes, pooled hazard ratios for CVD associated with five elevated risk factors versus optimal risk factor control were 1.09 (95% CI, 1.01 to 1.17) in people with cardiorenal disease and 1.96 (95% CI, 1.82 to 2.12) in people without cardiorenal disease. People without cardiorenal disease were younger and were more likely to have suboptimal risk factor control but had fewer prescriptions for risk factor-modifying medications than those with cardiorenal disease.
The study authors wrote that risk factor levels appeared to contribute little to the relative risk for the end point of combined fatal and nonfatal CVD events (9% relative risk between participants with optimal vs. poor control) but were strongly related to risk for fatal CVD (52% relative risk) among patients with cardiorenal disease.
“Our data supports early and more intensive intervention in people with [type 2 diabetes] who are perceived to be at lower risk (without established cardio-renal disease), whom on average, have higher body mass index, total cholesterol, HbA1c, and blood pressure levels than individuals with established cardio-renal disease,” the authors wrote. “Such intervention could yield substantial long-term reductions in CVD events and mortality at the population level.”