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
Article Figures & Tables
Figures
- Figure 1
Unadjusted CVD and CHD event rates per 1,000 person-years for subjects with DM, by status of being at target level for individual risk factors BP, LDL-C, and HbA1c (A) and by the number of risk factors at target levels (B). BP target <130/80 mmHg; LDL-C target <2.6 mmol/L (100 mg/dL); HbA1c target <53.0 mmol/mol (7%).
Tables
- Table 1
Characteristics of all participants with diagnosed DM and no CVD at baseline in the individual parent cohort studies and in the pooled sample
ARIC study MESA JHS All 3 studies pooled DM 825 740 453 2,018 Age (years) 58.5 ± 5.7 66.2 ± 9.5 53.6 ± 10.7 60.1 ± 9.7 Age range (years) 47–69 46–86 28–82 28–86 Male sex 355 (43.0%) 372 (50.3%) 143 (31.6%) 870 (43.1%) White 450 (54.6%) 152 (20.5%) N/A 602 (29.8%) African American 373 (45.2%) 278 (37.6%) 453 (100%) 1,104 (54.7%) Hispanic N/A 228 (30.8%) N/A 228 (11.3%) Asian/Pacific Islander 2 (0.2%) 72 (11.6%) N/A 84 (4.2%) DM duration (years) 10.0 ± 9.4 10.6 ± 8.4 8.6 ± 8.8 9.9 ± 9.0 BP at target (<130/80 mmHg) 431 (52.2%) 376 (50.8%) 37 (8.2%) 844 (41.8%) LDL-C at target (<2.6 mmol/L [100 mg/dL]) 157 (19.0%) 353 (47.7%) 137 (30.2%) 647 (32.1%) HbA1c at target (<53.0 mmol/mol [7%]) 266 (32.2%) 378 (50.1%) 201 (44.4%) 845 (41.9%) None (BP, LDL-C, HbA1c) at target 228 (27.6%) 104 (14.1%) 176 (38.9%) 508 (25.2%) Any one (BP, LDL-C, HbA1c) at target 374 (45.3%) 267 (36.1%) 189 (41.7%) 830 (41.1%) Any two (BP, LDL-C, HbA1c) at target 189 (22.9%) 267 (36.1%) 78 (17.2%) 534 (26.5%) All three (BP, LDL-C, HbA1c) at target 34 (4.1%) 102 (13.8%) 10 (2.2%) 146 (7.2%) Follow-up time (years) 14.9 ± 5.6 7.9 ± 1.4 8.0 ± 1.4 10.8 ± 5.1 Incident CVD (n/1,000 person-years) 444 (45.4) 105 (24.4) 65 (19.1) 614 (35.1) Incident CHD (n/1,000 person-years) 288 (26.9) 66 (14.9) 24 (6.8) 378 (20.3) Continuous variables are presented as the mean ± SD; categorical variables are presented as frequencies (%); incident events were presented as the number of events (event rates). The JHS (n = 3,675) excludes those counted in the ARIC study cohort. Asian/Pacific Islanders are all Chinese American in the MESA and except for two unspecified Asian/Pacific Islanders from the ARIC study. DM duration data were available in 602 ARIC study participants, 457 MESA participants, and 348 JHS participants.
- Table 2
Baseline characteristics by BP, LDL-C, HbA1c, and composite (BP, LDL-C, HbA1c) targets among subjects with DM from the pooled cohort
BP LDL-C HbA1c Composite target At target (<130/80 mmHg) (N = 844) Not at target (≥130/80 mmHg) (N = 1,174) At target (<2.6 mmol/L [100 mg/dL]) (N = 647) Not at target (≥2.6 mmol/L [100 mg/dL]) (N = 1,371) At target (<53.0 mmol/mol [7%]) (N = 845) Not at target (≥53.0 mmol/mol [7%]) (N = 1,173) At target (N = 146) Not at target (N = 1,872) Age, years 60.3 ± 8.4 59.9 ± 10.6 61.8 ± 10.4 59.3 ± 9.3§ 61.3 ± 10.4 59.3 ± 9.2§ 62.5 ± 9.4 59.9 ± 9.8† Male 386 (45.7%) 484 (41.2%)* 305 (47.1%) 565 (41.2%)* 383 (45.3%) 487 (41.5%) 79 (54.1%) 791 (42.3%)† African American 344 (40.8%) 760 (64.7%)§ 330 (51.0%) 774 (56.5%)* 434 (51.4%) 670 (57.1%)* 49 (33.6%) 1,055 (56.4%)§ Current smoker 157 (18.6%) 147 (12.5%)§ 95 (14.7%) 209 (15.2%) 127 (15.0%) 177 (15.11)† 25 (17.1%) 279 (14.9%)* Family history of CVD 429 (50.8%) 619 (52.7%) 337 (52.1%) 711 (51.8%) 434 (51.4%) 614 (52.3%) 76 (52.1%) 972 (51.9%) DM duration, years 10.6 ± 9.3 9.4 ± 8.7* 10.4 ± 9.5 9.6 ± 8.7* 8.7 ± 9.3 10.6 ± 8.7‡ 10.9 ± 10.8 9.8 ± 8.8 Systolic BP, mmHg 114.0 ± 9.8 145.2 ± 17.6§ 130.5 ± 20.3 132.9 ± 21.8* 131.4 ± 21.2 132.7 ± 21.5 113.7 ± 9.8 133.6 ± 21.4§ Diastolic BP, mmHg 65.6 ± 7.5 81.9 ± 12.7§ 73.6 ± 13.0 75.8 ± 13.6‡ 74.9 ± 13.5 75.2 ± 13.5 64.6 ± 8.5 75.9 ± 13.5§ LDL-C, mmol/L (mg/dL) 3.04 ± 0.99 (117.1 ± 37.9) 3.18 ± 1.00† (122.3 ± 38.5) 2.09 ± 0.39 (80.5 ± 14.9) 3.61 ± 0.82§ (138.8 ± 31.1) 2.98 ± 0.94 (114.4 ± 36.5) 3.24 ± 1.03§ (124.2 ± 39.1) 2.05 ± 0.38 (79.2 ± 14.7) 3.22 ± 0.99§ (123.3 ± 37.7) HDL-C, mmol/L (mg/dL) 1.14 ± 0.36 (45.7 ± 14.4) 1.18 ± 0.34* (47.2 ± 13.6) 1.18 ± 0.38 (47.0 ± 15.1) 1.16 ± 0.34 (46.4 ± 13.4) 1.20 ± 0.37 (47.9 ± 14.6) 1.14.3 ± 0.34§ (45.7 ± 13.5) 1.15 ± 0.39 (45.9 ± 15.7) 1.17 ± 0.35 (46.7 ± 13.8) HbA1c, mmol/mol (%) 59.1 ± 15.9 (7.8 ± 2.1) 59.1 ± 15.1 (7.8 ± 2.0) 56.0 ± 12.9 (7.4 ± 1.7) 60.6 ± 15.9§ (8.0 ± 2.1) 45.4 ± 3.8 (6.1 ± 0.5) 68.1 ± 13.6§ (9.0 ± 1.8) 45.4 ± 3.8 (6.1 ± 0.5) 59.8 ± 15.1§ (7.9 ± 2.0) BMI, kg/m2 30.8 ± 6.4 32.5 ± 6.8§ 31.5 ± 6.7 31.9 ± 6.7 31.3 ± 6.7 32.2 ± 6.7† 30.5 ± 6.2 31.9 ± 6.7* Hypertension medication 470 (55.7%) 868 (73.9%)§ 457 (70.6%) 881 (64.3%)† 559 (66.2%) 779 (66.4%) 87 (59.6%) 1,251 (66.8%) Antidiabetes medication 686 (81.3%) 934 (79.6%) 545 (84.2%) 1,075 (78.4%)‡ 594 (70.3%) 1,026 (87.5%)§ 113 (77.4%) 1,507 (80.5%) Lipid-lowering medication 202 (23.9%) 241 (20.5%) 225 (34.8%) 218 (15.9%)§ 197 (23.3%) 246 (21.0%) 54 (37.0%) 389 (20.8%)§ BP <130/80 mmHg 844 (100%) 298 (46.1%) 546 (39.8%)† 356 (42.1%) 488 (41.6%) 146 (100%) LDL-C <2.6 mmol/L (100 mg/dL) 298 (35.3%) 349 (29.7%)† 647 (100%) 318 (37.6%) 329 (28.1%)§ 146 (100%) HbA1c <53.0 mmol/mol (7%) 356 (42.2%) 489 (41.7%) 318 (49.2%) 527 (38.4%)§ 845 (100%) 146 (100%) HDL-C <1.0 mmol/L (40 mg/dL) (male) or <1.3 mmol/L (50 mg/dL) (female) 386 (45.7%) 589 (50.2%)* 304 (47.0%) 671 (48.9%) 449 (53.1%) 526 (44.8%)‡ 63 (43.2%) 912 (48.7%) Obesity (BMI ≥30 kg/m2) 414 (49.1%) 729 (62.1%)§ 368 (56.1%) 808 (56.6%) 438 (51.8%) 705 (60.1%)‡ 68 (46.6%) 1,075 (57.4%)* Continuous variables are expressed as the mean ± SD, and categorical variables are expressed as frequencies (%). BP, LDL-C, HbA1c, and HDL-C cut points are per previously recommended American Diabetes Association targets. DM duration data were available in 602 ARIC study participants, 457 MESA participants, and 348 JHS participants.
↵*P < 0.05, †P < 0.01, ‡P < 0.001, §P < 0.0001 compared with those at target.
- Table 3
Adjusted HRs (95% CI) for CVD and CHD events among subjects with DM by status of individual and composite risk factor targets
Risk factor comparison Incident CVD events Incident CHD events HR (95% CI), unadjusted HR (95% CI), adjusted for covariates HR (95% CI), adjusted for propensity score HR (95% CI), unadjusted HR (95% CI), adjusted for covariates HR (95% CI), adjusted for propensity score Individual risk factor controlled BP <130/80 mmHg vs. BP ≥130/80 mmHg 0.81 (0.69–0.95)* 0.83 (0.70–0.98)* 0.81 (0.68–0.96)* 0.86 (0.70–1.05) 0.83 (0.67–1.02) 0.78 (0.63–0.97)* LDL-C <2.6 mmol/L (100 mg/dL) vs. LDL-C ≥2.6 mmol/L (100 mg/dL) 0.71 (0.58–0.86)‡ 0.67 (0.54–0.82)§ 0.71 (0.58–0.87)‡ 0.64 (0.49–0.83)‡ 0.59 (0.45–0.77)‡ 0.62 (0.48–0.81)‡ HbA1c <53.0 mmol/mol (7%) vs. HbA1c ≥53.0 mmol/mol (7%) 0.64 (0.54–0.76)§ 0.63 (0.53–0.76)§ 0.70 (0.58–0.84)§ 0.68 (0.54–0.84)‡ 0.64 (0.51–0.81)‡ 0.74 (0.59–0.93)* Number of risk factors at target Any one (BP, LDL-C, HbA1c) at target vs. none at target 0.67 (0.56–0.80)§ 0.64 (0.53–0.77)§ 0.65 (0.54–0.78)§ 0.65 (0.52–0.82)‡ 0.59 (0.47–0.75)§ 0.60 (0.47–0.76)§ Any two (BP, LDL-C, HbA1c) at target vs. none at target 0.52 (0.41–0.64)§ 0.48 (0.38–0.61)§ 0.47 (0.38–0.60)§ 0.51 (0.38–0.68)§ 0.44 (0.33–0.59)§ 0.42 (0.32–0.57)§ All three (BP, LDL-C, HbA1c) at target vs. none at target 0.46 (0.30–0.69)‡ 0.38 (0.25–0.58)§ 0.41 (0.27–0.62)§ 0.53 (0.32–0.88)* 0.40 (0.24–0.67)‡ 0.41 (0.25–0.70)‡ Covariates include age, sex, ethnicity, smoking status, HDL-C, BMI, family history of premature CVD, hypertension medication, antidiabetes and lipid-lowering medication (also include LDL-C and HbA1c for BP analysis; systolic/diastolic BP and HbA1c for LDL-C analysis; LDL-C and systolic/diastolic BP for HbA1c analysis).
↵*P < 0.05, ‡P < 0.001, §P < 0.0001.
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