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Effect of Multifactorial Treatment Targets and Relative Importance of Hemoglobin A1c, Blood Pressure, and Low-Density Lipoprotein-Cholesterol on Cardiovascular Diseases in Chinese Primary Care Patients With Type 2 Diabetes Mellitus: A Population-Based Retrospective Cohort Study.
J Am Heart Assoc. 2017 Aug 17; 6(8)JA

Abstract

BACKGROUND

The relative effect of hemoglobin A1c, blood pressure, and low-density lipoprotein-cholesterol (LDL-C) ("ABC" factors) on the prevention of cardiovascular diseases (CVD) among patients with type 2 diabetes mellitus is poorly understood. This study aimed to evaluate the association of key clinical parameters on CVD risk using a multifactorial optimal control approach in Chinese primary care patients with type 2 diabetes mellitus.

METHODS AND RESULTS

A population-based retrospective cohort study was conducted on 144 271 Chinese type 2 diabetes mellitus primary care patients, aged 18 to 79 and without prior clinical diagnosis of CVD in 2008-2011. Cox regressions were conducted to examine the association between the combinations of ABC targets (hemoglobin A1c <7%, blood pressure <130/90 mm Hg, and LDL-C <2.6 mmol/L) and risks of CVD (overall), coronary heart disease, stroke, and heart failure. Achieving more ABC targets incrementally reduced the incidence of total CVD and individual disease including coronary heart disease, stroke, and heart failure, irrespective of other patient characteristics. Compared with suboptimal control in all ABC levels, achieving any 1, 2, and all 3 ABC targets reduced the relative risk of CVD by 13% to 42%, 31% to 52%, and 55%, respectively. Among those achieving only 1 ABC target, LDL-C reduction was associated with the greatest CVD risk reduction (42%), followed by blood pressure reduction (18%), and hemoglobin A1c reduction (13%).

CONCLUSIONS

To achieve the greatest risk reduction for the incidence of CVD, the ultimate goal of treatment should be to achieve target control of hemoglobin A1c, blood pressure, and LDL-C. If it is not possible to achieve all 3 targets, efforts should be prioritized on treating the LDL-C to minimize CVD risk.

Authors+Show Affiliations

Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong.Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong cfsc@hku.hk.Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong.Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong.School of Nursing, The University of Hong Kong, Hong Kong.Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong.Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28862945

Citation

Wan, Eric Yuk Fai, et al. "Effect of Multifactorial Treatment Targets and Relative Importance of Hemoglobin A1c, Blood Pressure, and Low-Density Lipoprotein-Cholesterol On Cardiovascular Diseases in Chinese Primary Care Patients With Type 2 Diabetes Mellitus: a Population-Based Retrospective Cohort Study." Journal of the American Heart Association, vol. 6, no. 8, 2017.
Wan EYF, Fung CSC, Yu EYT, et al. Effect of Multifactorial Treatment Targets and Relative Importance of Hemoglobin A1c, Blood Pressure, and Low-Density Lipoprotein-Cholesterol on Cardiovascular Diseases in Chinese Primary Care Patients With Type 2 Diabetes Mellitus: A Population-Based Retrospective Cohort Study. J Am Heart Assoc. 2017;6(8).
Wan, E. Y. F., Fung, C. S. C., Yu, E. Y. T., Chin, W. Y., Fong, D. Y. T., Chan, A. K. C., & Lam, C. L. K. (2017). Effect of Multifactorial Treatment Targets and Relative Importance of Hemoglobin A1c, Blood Pressure, and Low-Density Lipoprotein-Cholesterol on Cardiovascular Diseases in Chinese Primary Care Patients With Type 2 Diabetes Mellitus: A Population-Based Retrospective Cohort Study. Journal of the American Heart Association, 6(8). https://doi.org/10.1161/JAHA.117.006400
Wan EYF, et al. Effect of Multifactorial Treatment Targets and Relative Importance of Hemoglobin A1c, Blood Pressure, and Low-Density Lipoprotein-Cholesterol On Cardiovascular Diseases in Chinese Primary Care Patients With Type 2 Diabetes Mellitus: a Population-Based Retrospective Cohort Study. J Am Heart Assoc. 2017 Aug 17;6(8) PubMed PMID: 28862945.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of Multifactorial Treatment Targets and Relative Importance of Hemoglobin A1c, Blood Pressure, and Low-Density Lipoprotein-Cholesterol on Cardiovascular Diseases in Chinese Primary Care Patients With Type 2 Diabetes Mellitus: A Population-Based Retrospective Cohort Study. AU - Wan,Eric Yuk Fai, AU - Fung,Colman Siu Cheung, AU - Yu,Esther Yee Tak, AU - Chin,Weng Yee, AU - Fong,Daniel Yee Tak, AU - Chan,Anca Ka Chun, AU - Lam,Cindy Lo Kuen, Y1 - 2017/08/17/ PY - 2017/9/2/entrez PY - 2017/9/2/pubmed PY - 2018/6/12/medline KW - blood pressure KW - cardiovascular disease KW - diabetes mellitus KW - hemoglobin A1c KW - lipids JF - Journal of the American Heart Association JO - J Am Heart Assoc VL - 6 IS - 8 N2 - BACKGROUND: The relative effect of hemoglobin A1c, blood pressure, and low-density lipoprotein-cholesterol (LDL-C) ("ABC" factors) on the prevention of cardiovascular diseases (CVD) among patients with type 2 diabetes mellitus is poorly understood. This study aimed to evaluate the association of key clinical parameters on CVD risk using a multifactorial optimal control approach in Chinese primary care patients with type 2 diabetes mellitus. METHODS AND RESULTS: A population-based retrospective cohort study was conducted on 144 271 Chinese type 2 diabetes mellitus primary care patients, aged 18 to 79 and without prior clinical diagnosis of CVD in 2008-2011. Cox regressions were conducted to examine the association between the combinations of ABC targets (hemoglobin A1c <7%, blood pressure <130/90 mm Hg, and LDL-C <2.6 mmol/L) and risks of CVD (overall), coronary heart disease, stroke, and heart failure. Achieving more ABC targets incrementally reduced the incidence of total CVD and individual disease including coronary heart disease, stroke, and heart failure, irrespective of other patient characteristics. Compared with suboptimal control in all ABC levels, achieving any 1, 2, and all 3 ABC targets reduced the relative risk of CVD by 13% to 42%, 31% to 52%, and 55%, respectively. Among those achieving only 1 ABC target, LDL-C reduction was associated with the greatest CVD risk reduction (42%), followed by blood pressure reduction (18%), and hemoglobin A1c reduction (13%). CONCLUSIONS: To achieve the greatest risk reduction for the incidence of CVD, the ultimate goal of treatment should be to achieve target control of hemoglobin A1c, blood pressure, and LDL-C. If it is not possible to achieve all 3 targets, efforts should be prioritized on treating the LDL-C to minimize CVD risk. SN - 2047-9980 UR - https://www.unboundmedicine.com/medline/citation/28862945/Effect_of_Multifactorial_Treatment_Targets_and_Relative_Importance_of_Hemoglobin_A1c_Blood_Pressure_and_Low_Density_Lipoprotein_Cholesterol_on_Cardiovascular_Diseases_in_Chinese_Primary_Care_Patients_With_Type_2_Diabetes_Mellitus:_A_Population_Based_Retrospective_Cohort_Study_ L2 - https://www.ahajournals.org/doi/10.1161/JAHA.117.006400?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -