Katarina Eeg-Olofsson1, Björn Zethelius2, Soffia Gudbjörnsdottir1, Björn Eliasson1, Ann-Marie Svensson1, Jan Cederholm3. 1. Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden. 2. Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden Medical Products Agency, Uppsala, Sweden. 3. Family Medicine and Preventive Medicine, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden jan.cederholm@pubcare.uu.se.
Abstract
OBJECTIVES: Assess the effect of risk factors changes on risk for cardiovascular disease and mortality in patients with type 2 diabetes selected from the Swedish National Diabetes Register. METHODS: Observational study of 13,477 females and males aged 30-75 years, with baseline HbA1c 41-67 mmol/mol, systolic blood pressure 122-154 mmHg and ratio non-HDL:HDL 1.7-4.1, followed for mean 6.5 years until 2012. Four groups were created: a reference group (n = 6757) with increasing final versus baseline HbA1c, systolic blood pressure and non-HDL:HDL cholesterol during the study period, and three groups with decreasing HbA1c (n = 1925), HbA1c and systolic blood pressure (n = 2050) or HbA1c and systolic blood pressure and non-HDL:HDL (n = 2745). RESULTS: Relative risk reduction for fatal/nonfatal cardiovascular disease was 35% with decrease in HbA1c only (mean 6 to final 49 mmol/mol), 56% with decrease in HbA1c and systolic blood pressure (mean 12 to final 128 mmHg) and 75% with combined decreases in HbA1c, systolic blood pressure and non-HDL:HDL (mean 0.8 to final 2.1), all p < 0.001 adjusting for clinical characteristics, other risk factors, treatments and previous cardiovascular disease. Similar risk reductions were found for fatal/nonfatal coronary heart disease, fatal cardiovascular disease, all-cause mortality and also in a subgroup of 3038 patients with albuminuria. CONCLUSION: Considerable risk reductions for cardiovascular disease and mortality were seen with combined long-term risk factor improvement.
OBJECTIVES: Assess the effect of risk factors changes on risk for cardiovascular disease and mortality in patients with type 2 diabetes selected from the Swedish National Diabetes Register. METHODS: Observational study of 13,477 females and males aged 30-75 years, with baseline HbA1c 41-67 mmol/mol, systolic blood pressure 122-154 mmHg and ratio non-HDL:HDL 1.7-4.1, followed for mean 6.5 years until 2012. Four groups were created: a reference group (n = 6757) with increasing final versus baseline HbA1c, systolic blood pressure and non-HDL:HDL cholesterol during the study period, and three groups with decreasing HbA1c (n = 1925), HbA1c and systolic blood pressure (n = 2050) or HbA1c and systolic blood pressure and non-HDL:HDL (n = 2745). RESULTS: Relative risk reduction for fatal/nonfatal cardiovascular disease was 35% with decrease in HbA1c only (mean 6 to final 49 mmol/mol), 56% with decrease in HbA1c and systolic blood pressure (mean 12 to final 128 mmHg) and 75% with combined decreases in HbA1c, systolic blood pressure and non-HDL:HDL (mean 0.8 to final 2.1), all p < 0.001 adjusting for clinical characteristics, other risk factors, treatments and previous cardiovascular disease. Similar risk reductions were found for fatal/nonfatal coronary heart disease, fatal cardiovascular disease, all-cause mortality and also in a subgroup of 3038 patients with albuminuria. CONCLUSION: Considerable risk reductions for cardiovascular disease and mortality were seen with combined long-term risk factor improvement.
Authors: Åsne Bakke; John G Cooper; Geir Thue; Svein Skeie; Siri Carlsen; Ingvild Dalen; Karianne Fjeld Løvaas; Tone Vonheim Madsen; Ellen Renate Oord; Tore Julsrud Berg; Tor Claudi; Anh Thi Tran; Bjørn Gjelsvik; Anne Karen Jenum; Sverre Sandberg Journal: BMJ Open Diabetes Res Care Date: 2017-11-08
Authors: Viveca Gyberg; Dirk De Bacquer; Kornelia Kotseva; Guy De Backer; Oliver Schnell; Jaakko Tuomilehto; David Wood; Lars Rydén Journal: BMJ Open Date: 2016-12-08 Impact factor: 2.692
Authors: Anh Thi Tran; Åsne Bakke; Tore J Berg; Bjørn Gjelsvik; Ibrahimu Mdala; Kjersti Nøkleby; Anam Shakil Rai; John G Cooper; Tor Claudi; Karianne Løvaas; Geir Thue; Sverre Sandberg; Anne K Jenum Journal: Scand J Prim Health Care Date: 2018-06 Impact factor: 2.581