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Diabetes Care. 2015 May;38(5):905-12. doi: 10.2337/dc14-1877. Epub 2015 Feb 20.

Preventable major cardiovascular events associated with uncontrolled glucose, blood pressure, and lipids and active smoking in adults with diabetes with and without cardiovascular disease: a contemporary analysis.

Author information

1
HealthPartners Institute for Education and Research, Minneapolis, MN gabriela.x.vazquezbenitez@healthpartners.com.
2
HealthPartners Institute for Education and Research, Minneapolis, MN.
3
Kaiser Permanente Institute for Health Research, Denver, CO.
4
Kaiser Permanente Center for Health Research, Portland, OR.
5
Johns Hopkins Medicine, Baltimore, MD.
6
Kaiser Permanente Georgia, Center for Health Research Southeast, Atlanta, GA.
7
Division of Research, Kaiser Permanente Northern California, Oakland, CA.
8
Group Health Research Institute, Seattle, WA.
9
University of Washington School of Medicine, Seattle, WA.
10
Department of Endocrinology, Marshfield Clinic, Marshfield, WI.
11
Lutheran Medical Center, Brooklyn, NY.
12
Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
13
Geisinger Health System, Danville, PA.
14
Kaiser Permanente Center for Health Research, Honolulu, HI.
15
Lutheran Medical Center, Brooklyn, NY Virginia Commonwealth University School of Medicine, Richmond, VA.

Abstract

OBJECTIVE:

The objective of this study was to assess the incidence of major cardiovascular (CV) hospitalization events and all-cause deaths among adults with diabetes with or without CV disease (CVD) associated with inadequately controlled glycated hemoglobin (A1C), high LDL cholesterol (LDL-C), high blood pressure (BP), and current smoking.

RESEARCH DESIGN AND METHODS:

Study subjects included 859,617 adults with diabetes enrolled for more than 6 months during 2005-2011 in a network of 11 U.S. integrated health care organizations. Inadequate risk factor control was classified as LDL-C ≥100 mg/dL, A1C ≥7% (53 mmol/mol), BP ≥140/90 mm Hg, or smoking. Major CV events were based on primary hospital discharge diagnoses for myocardial infarction (MI) and acute coronary syndrome (ACS), stroke, or heart failure (HF). Five-year incidence rates, rate ratios, and average attributable fractions were estimated using multivariable Poisson regression models.

RESULTS:

Mean (SD) age at baseline was 59 (14) years; 48% of subjects were female, 45% were white, and 31% had CVD. Mean follow-up was 59 months. Event rates per 100 person-years for adults with diabetes and CVD versus those without CVD were 6.0 vs. 1.7 for MI/ACS, 5.3 vs. 1.5 for stroke, 8.4 vs. 1.2 for HF, 18.1 vs. 40 for all CV events, and 23.5 vs. 5.0 for all-cause mortality. The percentages of CV events and deaths associated with inadequate risk factor control were 11% and 3%, respectively, for those with CVD and 34% and 7%, respectively, for those without CVD.

CONCLUSIONS:

Additional attention to traditional CV risk factors could yield further substantive reductions in CV events and mortality in adults with diabetes.

PMID:
25710922
PMCID:
PMC4876667
DOI:
10.2337/dc14-1877
[Indexed for MEDLINE]
Free PMC Article

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