Nathan D Wong1, Yanglu Zhao2, Rohini Patel3, Christopher Patao3, Shaista Malik3, Alain G Bertoni4, Adolfo Correa5, Aaron R Folsom6, Sumesh Kachroo7, Jayanti Mukherjee7, Herman Taylor5, Elizabeth Selvin8. 1. Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA ndwong@uci.edu. 2. Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA. 3. Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA. 4. Department of Epidemiology & Prevention, Wake Forest University, Winston-Salem, NC. 5. Department of Medicine, University of Mississippi Medical Center, Jackson, MS. 6. Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN. 7. Health Economics and Outcomes Research, Bristol-Myers Squibb, Wallingford, CT. 8. Department of Epidemiology, Johns Hopkins University, Baltimore, MD.
Abstract
OBJECTIVE: Controlling cardiovascular disease (CVD) risk factors in diabetes mellitus (DM) reduces the number of CVD events, but the effects of multifactorial risk factor control are not well quantified. We examined whether being at targets for blood pressure (BP), LDL cholesterol (LDL-C), and glycated hemoglobin (HbA1c) together are associated with lower risks for CVD events in U.S. adults with DM. RESEARCH DESIGN AND METHODS: We studied 2,018 adults, 28-86 years of age with DM but without known CVD, from the Atherosclerosis Risk in Communities (ARIC) study, Multi-Ethnic Study of Atherosclerosis (MESA), and Jackson Heart Study (JHS). Cox regression examined coronary heart disease (CHD) and CVD events over a mean 11-year follow-up in those individuals at BP, LDL-C, and HbA1c target levels, and by the number of controlled risk factors. RESULTS: Of 2,018 DM subjects (43% male, 55% African American), 41.8%, 32.1%, and 41.9% were at target levels for BP, LDL-C, and HbA1c, respectively; 41.1%, 26.5%, and 7.2% were at target levels for any one, two, or all three factors, respectively. Being at BP, LDL-C, or HbA1c target levels related to 17%, 33%, and 37% lower CVD risks and 17%, 41%, and 36% lower CHD risks, respectively (P < 0.05 to P < 0.0001, except for BP in CHD risk); those subjects with one, two, or all three risk factors at target levels (vs. none) had incrementally lower adjusted risks of CVD events of 36%, 52%, and 62%, respectively, and incrementally lower adjusted risks of CHD events of 41%, 56%, and 60%, respectively (P < 0.001 to P < 0.0001). Propensity score adjustment showed similar findings. CONCLUSIONS: Optimal levels of BP, LDL-C, and HbA1c occurring together in individuals with DM are uncommon, but are associated with substantially lower risk of CHD and CVD.
OBJECTIVE: Controlling cardiovascular disease (CVD) risk factors in diabetes mellitus (DM) reduces the number of CVD events, but the effects of multifactorial risk factor control are not well quantified. We examined whether being at targets for blood pressure (BP), LDL cholesterol (LDL-C), and glycated hemoglobin (HbA1c) together are associated with lower risks for CVD events in U.S. adults with DM. RESEARCH DESIGN AND METHODS: We studied 2,018 adults, 28-86 years of age with DM but without known CVD, from the Atherosclerosis Risk in Communities (ARIC) study, Multi-Ethnic Study of Atherosclerosis (MESA), and Jackson Heart Study (JHS). Cox regression examined coronary heart disease (CHD) and CVD events over a mean 11-year follow-up in those individuals at BP, LDL-C, and HbA1c target levels, and by the number of controlled risk factors. RESULTS: Of 2,018 DM subjects (43% male, 55% African American), 41.8%, 32.1%, and 41.9% were at target levels for BP, LDL-C, and HbA1c, respectively; 41.1%, 26.5%, and 7.2% were at target levels for any one, two, or all three factors, respectively. Being at BP, LDL-C, or HbA1c target levels related to 17%, 33%, and 37% lower CVD risks and 17%, 41%, and 36% lower CHD risks, respectively (P < 0.05 to P < 0.0001, except for BP in CHD risk); those subjects with one, two, or all three risk factors at target levels (vs. none) had incrementally lower adjusted risks of CVD events of 36%, 52%, and 62%, respectively, and incrementally lower adjusted risks of CHD events of 41%, 56%, and 60%, respectively (P < 0.001 to P < 0.0001). Propensity score adjustment showed similar findings. CONCLUSIONS: Optimal levels of BP, LDL-C, and HbA1c occurring together in individuals with DM are uncommon, but are associated with substantially lower risk of CHD and CVD.
Authors: Giuseppina Imperatore; Betsy L Cadwell; Linda Geiss; Jinan B Saadinne; Desmond E Williams; Earl S Ford; Theodore J Thompson; K M Venkat Narayan; Edward W Gregg Journal: Am J Epidemiol Date: 2004-09-15 Impact factor: 4.897
Authors: Myra A Carpenter; Richard Crow; Michael Steffes; William Rock; Jeffrey Heilbraun; Gregory Evans; Thomas Skelton; Robert Jensen; Daniel Sarpong Journal: Am J Med Sci Date: 2004-09 Impact factor: 2.378
Authors: Lawrence R Krakoff; Robert L Gillespie; Keith C Ferdinand; Icilma V Fergus; Ola Akinboboye; Kim A Williams; Mary Norine Walsh; C Noel Bairey Merz; Carl J Pepine Journal: J Am Coll Cardiol Date: 2014-07-29 Impact factor: 24.094
Authors: Helen M Colhoun; D John Betteridge; Paul N Durrington; Graham A Hitman; H Andrew W Neil; Shona J Livingstone; Margaret J Thomason; Michael I Mackness; Valentine Charlton-Menys; John H Fuller Journal: Lancet Date: 2004 Aug 21-27 Impact factor: 79.321
Authors: Caroline S Fox; Sherita Hill Golden; Cheryl Anderson; George A Bray; Lora E Burke; Ian H de Boer; Prakash Deedwania; Robert H Eckel; Abby G Ershow; Judith Fradkin; Silvio E Inzucchi; Mikhail Kosiborod; Robert G Nelson; Mahesh J Patel; Michael Pignone; Laurie Quinn; Philip R Schauer; Elizabeth Selvin; Dorothea K Vafiadis Journal: Circulation Date: 2015-08-05 Impact factor: 29.690
Authors: Nathan D Wong; Yanglu Zhao; Ruben G W Quek; Roger S Blumenthal; Matthew J Budoff; Mary Cushman; Parveen Garg; Veit Sandfort; Michael Tsai; J Antonio G Lopez Journal: J Clin Lipidol Date: 2017-06-30 Impact factor: 4.766
Authors: Jiayun Lu; Ina Zaimi; John R Barber; Corinne E Joshu; Anna E Prizment; James D Beck; Elizabeth A Platz; Dominique S Michaud Journal: Ann Epidemiol Date: 2019-08-22 Impact factor: 3.797