title: Cardiovascular risk factor control among veterans with diabetes: the ambulatory care quality improvement project.
abstract: OBJECTIVE
  To describe the extent to which hyperglycemia, hypertension, and dyslipidemia are currently detected, treated, and controlled in U.S. veterans with diabetes with and without ischemic heart disease (IHD).
  
  
  METHODS
  A cohort of 3,769 veterans who self-reported diabetes and who received all health care from the Veterans Administration (VA) medical centers were selected from subjects enrolled in the Ambulatory Care Quality Improvement Project, a randomized health services intervention at seven VA primary care clinics. IHD was defined by a self-reported history of myocardial ischemia, infarction, or revascularization. Mean values of HbA(1c), blood pressure, and cholesterol subfractions were collected from computerized laboratory databases. Medication data were collected from computerized pharmacy databases.
  
  
  RESULTS
  Mean HbA(1c) and optimal control (HbA(1c) <7%) did not differ for those without and with IHD: 8.1 vs. 8.0%, and 26 vs. 24%, respectively. Veterans with IHD were more likely to have hypertension (73 vs. 64%), to be treated (88 vs. 78%), and to have optimal blood pressure control (19 vs. 10%) compared with veterans without IHD (all P values <0.01). Veterans with IHD were more likely to have dyslipidemia (81 vs. 53%), were equally likely to be treated (54 vs. 50%), and were more likely to have optimal LDL levels (30 vs. 16%) compared with veterans without IHD, all P values <0.01.
  
  
  CONCLUSIONS
  Optimal cardiovascular risk factor control was the exception in this cohort of diabetic veterans attending primary care clinics. More aggressive management of cardiovascular risk factors in veterans with diabetes may be warranted, especially among those without prevalent IHD.
authors.affiliation: Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA. nlsmith@u.washington.edu
authors.forename: Nicholas L
authors.initials: NL
authors.lastname: Smith
authors.forename: Leway
authors.initials: L
authors.lastname: Chen
authors.forename: David H
authors.initials: DH
authors.lastname: Au
authors.forename: Mary
authors.initials: M
authors.lastname: McDonell
authors.forename: Stephan D
authors.initials: SD
authors.lastname: Fihn
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000592:standards; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000517:prevention & control; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000517:prevention & control; D004522:Educational Status; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans