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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)668-676
Number of pages9
JournalDiabetes Care
Volume39
Issue number5
DOIs
StatePublished - May 1 2016

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Atherosclerosis
Cardiovascular Diseases
LDL Cholesterol
Coronary Disease
Diabetes Mellitus
Blood Pressure
Propensity Score
Glycosylated Hemoglobin A
African Americans
Research Design

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

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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. / Wong, Nathan D.; Zhao, Yanglu; Patel, Rohini; Patao, Christopher; Malik, Shaista; Bertoni, Alain G.; Correa, Adolfo; Folsom, Aaron R.; Kachroo, Sumesh; Mukherjee, Jayanti; Taylor, Herman; Selvin, Elizabeth.

In: Diabetes Care, Vol. 39, No. 5, 01.05.2016, p. 668-676.

Research output: Contribution to journalArticle

Wong, Nathan D. ; Zhao, Yanglu ; Patel, Rohini ; Patao, Christopher ; Malik, Shaista ; Bertoni, Alain G. ; Correa, Adolfo ; Folsom, Aaron R. ; Kachroo, Sumesh ; Mukherjee, Jayanti ; Taylor, Herman ; Selvin, Elizabeth. / 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. In: Diabetes Care. 2016 ; Vol. 39, No. 5. pp. 668-676.
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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.",
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T1 - Cardiovascular risk factor targets and cardiovascular disease event risk in diabetes

T2 - A pooling project of the atherosclerosis risk in communities study, multi-ethnic study of atherosclerosis, and jackson heart study

AU - Wong, Nathan D.

AU - Zhao, Yanglu

AU - Patel, Rohini

AU - Patao, Christopher

AU - Malik, Shaista

AU - Bertoni, Alain G.

AU - Correa, Adolfo

AU - Folsom, Aaron R.

AU - Kachroo, Sumesh

AU - Mukherjee, Jayanti

AU - Taylor, Herman

AU - Selvin, Elizabeth

PY - 2016/5/1

Y1 - 2016/5/1

N2 - 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.

AB - 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.

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