The long-term effectiveness of metabolic control on cardiovascular disease in patients with diabetes in a real-world health care setting — A prospective diabetes management study

Document Type

Article

Publication Date

6-1-2020

Abstract

Aims: To determine the incidence rates of cardiovascular disease (CVD) and assess the effect of metabolic risk factor management on the development of CVD in patients with diabetes. Methods: We studied 733 patients with diabetes without prior CVD in the Shanghai Taopu community health service center. Success in managing CVD risk factors was evaluated as follows: (1) glucose control (haemoglobin A1c [HbA1c] <7.0% in patients aged <65 years and <8.0% in patients aged ≥65 years), (2) blood pressure control (<140/90 mmHg), and (3) lipid control (high-density lipoprotein cholesterol ≥1.0 mmol/L in men and ≥1.3 mmol/L in women, and triglycerides <1.7 mmol/L). Results: During a median 8.0-year follow-up, 206 CVD incident cases were identified. Each 1% increment in HbA1c, 10 mmHg increment in systolic blood pressure (SBP), and 1 mmol/L increment in triglycerides during follow-up significantly increased the risk of CVD by 17%, 37%, and 14%, respectively. Compared to those who did not, patients who met the blood pressure and glucose control goals during follow-up had a 64% and a 29% decreased risk of CVD, respectively. The multivariable-adjusted hazard ratios of CVD were 1.00, 1.78 (95% confidence interval [CI] 1.10–2.87), and 2.51 (95% CI 1.54–4.07) among patients who attained three, two, and one/none of the CVD factor control goals (HbA1c, blood pressure, and lipid) during follow-up, respectively. Conclusions: Average levels of HbA1c, SBP, and triglycerides during follow-up were positively associated with the risk of CVD, and treatment targeting multiple factors can significantly reduce CVD risk.

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