Effects of Treatment Targets on Subsequent Cardiovascular Events in Chinese Patients With Type 2 Diabetes
- Alice P.S. Kong, FRCP12,
- Xilin Yang, PHD1,
- Gary T.C. Ko, MD3,
- Wing-Yee So, FRCP2,
- Wing-Bun Chan, FRCP24,
- Ronald C.W. Ma, MRCP2,
- Vanessa W.S. Ng, MRCP2,
- Chun-Chung Chow, FRCP2,
- Clive S. Cockram, MD2,
- Peter C.Y. Tong, PHD2,
- Vivian Wong, MD5 and
- Juliana C.N. Chan, MD2
- 1Li Ka Shing Institute of Health Sciences, Hong Kong, China
- 2Department of Medicine and Therapeutics, Hong Kong, China
- 3Alice Ho ML Nethersole Hospital, Hong Kong, China
- 4Qualigenics Diabetes Centre, The Chinese University of Hong Kong, Hong Kong, China
- 5Hospital Authority, Hong Kong, China
- Address correspondence and reprint requests to Gary Ko, Department of Medicine, AH Nethersole Hospital, 11, Chuen On Road, Tai Po, NT, Hong Kong. E-mail: gtc_ko{at}hotmail.com
Abstract
OBJECTIVE—International guidelines recommend optimal control of risk factors in diabetes to prevent cardiovascular events. We examined risk associations between achieving treatment targets for glycemia, blood pressure and lipid control, and other risk factors on subsequent cardiovascular events in Chinese patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS—Between 1995 and 2005, 6,386 Chinese type 2 diabetic patients without a history of coronary heart disease (CHD) or stroke were recruited. They were classified according to the number of treatment targets attained at baseline, and their cardiovascular outcomes were compared. Treatment targets were defined as A1C <7.0%, blood pressure <130/80 mmHg, and LDL cholesterol <2.6 mmol/l.
RESULTS—After a median follow-up of 5.7 years, cumulative incidence of CHD or stroke (n = 749) increased with decreasing numbers of treatment targets attained at baseline. Attainment of two or more targets at baseline was associated with reduced risk of CHD compared with those with no target achieved (hazard ratio 0.69 [95% CI 0.50–0.94], P = 0.020). However, the association lost its significance after adjustment for urinary albumin-to-creatinine ratio, estimated glomerular filtration rate, and hemoglobin.
CONCLUSIONS—Reaching more treatment targets was associated with reduced risk of new onset of CHD in Chinese patients with type 2 diabetes.
- ACEI, ACE inhibitor
- ACR, albumin-to-creatinine ratio
- ARB, angiotensin-II receptor blocker
- CHD, coronary heart disease
- GFR, glomerular filtration rate
- IQR, interquartile range
Footnotes
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Published ahead of print at http://care.diabetesjournals.org on 26 January 2007. DOI: 10.2337/dc06-2443.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.
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- Accepted January 11, 2007.
- Received November 30, 2006.
- DIABETES CARE
