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Lipid, BP control lowered CVD hospitalization in patients with diabetes
The management of type 2 diabetes requires multiple strategies that range from treatment for dyslipidemia, hypertension, hyperglycemia and cardiovascular disease. Researchers from Kaiser Permanente examined these factors and found that proper maintenance of systolic blood pressure or LDL cholesterol significantly reduced CV hospitalizations among patients with diabetes.
“People with diabetes are often focused on controlling their blood sugar, but our study found that controlling blood pressure and cholesterol is even more important in preventing heart disease,” Gregory Nichols, PhD, researcher and senior investigator with Kaiser Permanente Center for Health Research, said in a press release. “This doesn’t mean that people with diabetes should ignore their blood sugar levels. They should still get regular HbA1c tests to measure and control their blood glucose, but it’s also important to pay attention to other factors that increase the risk for cardiovascular disease.”
In a non-concurrent longitudinal cohort study, Nichols and colleagues followed 26,636 patients with type 2 diabetes for a mean of 5.6 years until they died, left the study or Dec. 31, 2010. Researchers sought to determine the independent association of HbA1c control, systolic BP and LDL cholesterol with the risk for CVD hospitalization.
The highest rate of CVD hospitalization was observed in patients without controlled risk factors (18.2/1,000 person-years; 95% CI, 16.5-20.2) or those with only their HbA1c under control (16.9; 95% CI, 15-19). The lowest rates occurred in patients with all three risk factors controlled (7.2; 95% CI, 6.2-8.4) or with systolic BP and LDL in control (6.1; 95% CI, 5.1-7.2).
Maintaining systolic BP <130 mm Hg or LDL cholesterol <100 mg/dL was significantly associated with a reduced risk for CVD hospitalization. This was especially true when both risk factors were also controlled, researchers concluded. Finally, lowering HbA1c to <7% was not found to be independently associated with a reduced risk for CVD hospitalization.
Disclosure: The researchers report funding from AstraZeneca and Bristol-Myers Squibb.
Perspective
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The study by Nichols and colleagues reaffirms what has been known about cardiovascular risk management for the past decade. More specifically, glycemic control, while beneficial, will not have an impact on CV risk the way blood pressure and cholesterol management will. In fact, summarizing 50 years of research one could say with some confidence that reducing BP will have a major effect on slowing kidney disease progression and reducing stroke risk, cholesterol control will reduce risk for myocardial infarction, and glycemic control will protect against blindness and nerve injury. Clearly, they overlap but the predominant effect is as stated. More recently, we have learned that lowering BP to <130/80 mm Hg does not provide additional benefits in all; but in those who can tolerate this level, stroke risk is further reduced. In short, physicians should focus on controlling all risk factors as they do overall in their benefit and each brings a different benefit to the table.