Study: CVD in type 2 diabetics can be reduced or eliminated
Patients with type 2 diabetes (T2D), who met target ranges for five particular cardiovascular risk factors, appeared to have little or no excess risk of death, myocardial infarction (MI) or stroke, according to a new study published Aug. 16 in the New England Journal of Medicine.
The five risk factors were elevated glycated hemoglobin levels, elevated low-density lipoprotein (LDL) cholesterol level, albuminuria, smoking and elevated blood pressure.
“Patients with T2D have risks of death and cardiovascular events that are two to four times as great as the risks in the general population,” wrote lead author Aidin Rawshani, MD, of the Sahlgrenska Academy at the University of Gothenburg in Sweden, and colleagues. “Results from randomized trials support a range of interventions that target isolated risk factors such as elevated levels of glycated hemoglobin, blood pressure, and cholesterol to prevent or postpone complication of T2D.”
Rawshani and colleagues noted a paucity in literature highlighting whether the increased risk of death and cardiovascular events in patients with T2D could be reduced or eliminated using evidence-based treatments and risk-factor modification.
Using the Swedish National Diabetes Register, they assessed the health data of 300,000 T2D patients according to age and the presence of risk factors. During an average follow-up time of almost six years, the researchers discovered more than 175,000 deaths.
They found that diabetics who had all five risk factors within target ranges had no more than a 10 percent increased risk of premature death, MI, or stroke, compared to non-diabetics. However, they did note that those with all five risk factors within targets still had a 45 percent increased risk for developing heart failure, compared to non-diabetics. Additionally, they found:
- Glycated hemoglobin levels outside of the target range in diabetics was the strongest predictor of stroke and MI.
- Low physical activity was a strong predictor of cardiovascular outcomes and death, though smoking was the strongest predictor of death.
- Systolic blood pressure was a central factor for all outcomes in diabetics.
- Lower systolic blood pressure readings in diabetics were associated with lower risks cardiovascular outcomes—including significantly lower risks of MI and stroke.
- Lower levels of glycated hemoglobin and LDL cholesterol were also associated with lower risks of MI and stroke.
- The risk of cardiovascular outcomes and death is the highest among individuals aged 55 and under.
The researchers noted that systolic blood pressure and its relation to death and heart failure is more difficult to assess, as there is the potential for reverse causality. As it is a central factor for all outcomes in diabetics, they suggest more specific trials of blood-pressure reduction to differential targets in patients with T2D may be warranted.
As a senior news writer for TriMed, Subrata covers cardiology, clinical innovation and healthcare business. She has a master’s degree in communication management and 12 years of experience in journalism and public relations.