Improving Risk Factors May Cut Risk of Cardiovascular Outcomes, Mortality

Patients with type 2 diabetes who improve several risk factors saw a reduction in the risk of death, myocardial infarction, or stroke, a new study in the New England Journal of Medicine reported. 

Researchers for the study included 271,174 patients with type 2 diabetes and matched them with 1,355,870 matched controls. The authors specifically focused on 5 risk factors in patients with diabetes: elevated glycated hemoglobin levels, elevated LDL-C level, albuminuria, smoking, and elevated blood pressure. They used Cox regression models to evaluate excess risk of outcomes and looked at the relationship between the risk factors and cardiovascular outcomes. 

Patients with type 2 diabetes who had five risk-factor variables within the target ranges appeared to have little or no excess risk of death, myocardial infarction, or stroke, as compared with the general population. Learn more: https://t.co/gURQcykvvg pic.twitter.com/NuVbqKgjxQ

— NEJM (@NEJM) August 15, 2018

According to the results, the excess risk of outcomes decreased for each factor that was brought to within target range. In patients who brought all five risk factors into range, hazard ratios were 1.06 (95% CI, 1.00 to 1.12) for death from any cause, 0.84 (95% CI, 0.75 to 0.93) for myocardial infarction, and 0.95 (95% CI, 0.84 to 1.07) for stroke. Risk for hospitalization due to heart failure was higher in patients with diabetes. Smoking was the strongest predictor of death, and glycated hemoglobin levels outside of target range were the strongest predictors of stroke.  

“Patients with type 2 diabetes who had five risk-factor variables within the target ranges appeared to have little or no excess risk of death, myocardial infarction, or stroke, as compared with the general population,” the researchers wrote in their abstract. 

Excess risk of heart failure with diabetes, even if all 5 risk factors were at target levels. Role for SGLT2 inhibitors to address this risk?

— Gregg Fonarow MD (@gcfmd) August 15, 2018

Why HDL and TG were not part of the risk factors analysis?

— Jasmin Levallois, MD (@jlevallois) August 16, 2018

Rawshani brothers at it again. Brilliant minds! Pride and joy of the Sahlgrenska Academy.

— Gustaf L (@GotPed) August 15, 2018

Source: New England Journal of Medicine