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Original Research
Cardiovascular Risk Factor Targets and Cardiovascular Disease Event Risk in Diabetes, a Pooling Project of the Atherosclerosis Risk in Communities Study, Multi-Ethnic Study of Atherosclerosis, and Jackson Heart Study
Nathan D. Wong, Yanglu Zhao, Rohini Patel, Christopher Patao, Shaista Malik, Alain G. Bertoni, Adolfo Correa, Aaron R. Folsom, Sumesh Kachroo, Jayanti Mukherjee, Herman Taylor and Elizabeth Selvin
Diabetes Care 2016 Mar; dc152439. https://doi.org/10.2337/dc15-2439
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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.

  • Received November 10, 2015.
  • Accepted February 25, 2016.
  • © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
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Diabetes Care: 41 (4)

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April 2018
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Cardiovascular Risk Factor Targets and Cardiovascular Disease Event Risk in Diabetes, a Pooling Project of the Atherosclerosis Risk in Communities Study, Multi-Ethnic Study of Atherosclerosis, and Jackson Heart Study
Nathan D. Wong, Yanglu Zhao, Rohini Patel, Christopher Patao, Shaista Malik, Alain G. Bertoni, Adolfo Correa, Aaron R. Folsom, Sumesh Kachroo, Jayanti Mukherjee, Herman Taylor, Elizabeth Selvin
Diabetes Care Mar 2016, dc152439; DOI: 10.2337/dc15-2439

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Cardiovascular Risk Factor Targets and Cardiovascular Disease Event Risk in Diabetes, a Pooling Project of the Atherosclerosis Risk in Communities Study, Multi-Ethnic Study of Atherosclerosis, and Jackson Heart Study
Nathan D. Wong, Yanglu Zhao, Rohini Patel, Christopher Patao, Shaista Malik, Alain G. Bertoni, Adolfo Correa, Aaron R. Folsom, Sumesh Kachroo, Jayanti Mukherjee, Herman Taylor, Elizabeth Selvin
Diabetes Care Mar 2016, dc152439; DOI: 10.2337/dc15-2439
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© 2018 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.