Atherosclerotic disease location and disparities in the control and treatment of cardiovascular risk factors in patients with Type 2 diabetes.
OBJECTIVE
To assess whether differences exist in the control and intensity of medication treatment of cardiovascular risk factors in secondary prevention patients with Type 2 diabetes, depending on their atherosclerotic disease territory [coronary artery disease (CAD), cerebrovascular disease (CBVD) or peripheral arterial disease (PAD)].


METHODS
Cross-sectional analysis of 17 571 patients with Type 2 diabetes with prevalent atherosclerotic disease. Endpoints included uncontrolled cardiovascular disease (CVD) risk factors [systolic blood pressure (SBP) > or = 140 mmHg, low-density lipoprotein cholesterol > or = 3.4 mmol/l and glycated haemoglobin > or = 8.0%] and high intensity of medication treatment (defined as > or = 2 classes of anti-hypertensive agents, > or = 1 lipid-lowering agent or either insulin or > or = 2 oral glucose-lowering agents) in patients with uncontrolled CVD risk factors. Multiple-adjusted odds ratios were calculated for CAD, CBVD and PAD after adjusting for sex, age, body mass index, current smoking and diabetes duration.


RESULTS
Proportions of patients with uncontrolled risk factors were significantly different among disease territories. Decreased odds of having lipids not controlled were observed in patients with CAD, while decreased odds of having systolic blood pressure not controlled were observed in patients with PAD. PAD was associated with the highest odds of hyperglycaemia not being controlled. High-intensity treatment was observed in lipid and blood glucose management but not in hypertension management, independent of disease location.


CONCLUSIONS
In subjects with Type 2 diabetes and atherosclerotic disease, control of modifiable CVD risk factors but not intensity of medication treatment is modified by atherosclerotic disease territory. Intensity of medication treatment is different between risk factors.
Berthold
H K
HK
Lipid Clinic at the Interdisciplinary Metabolism Center, Charité University Medicine Berlin, Berlin, Germany. heiner.berthold@charite.de
Bestehorn
K P
KP
Krone
W
W
Gouni-Berthold
I
I
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000150:complications* / Q000503:physiopathology; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000097:blood; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors
D000959:Antihypertensive Agents; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin