title: Preventable major cardiovascular events associated with uncontrolled glucose, blood pressure, and lipids and active smoking in adults with diabetes with and without cardiovascular disease: a contemporary analysis.
abstract: OBJECTIVE
  The objective of this study was to assess the incidence of major cardiovascular (CV) hospitalization events and all-cause deaths among adults with diabetes with or without CV disease (CVD) associated with inadequately controlled glycated hemoglobin (A1C), high LDL cholesterol (LDL-C), high blood pressure (BP), and current smoking.
  
  
  METHODS
  Study subjects included 859,617 adults with diabetes enrolled for more than 6 months during 2005-2011 in a network of 11 U.S. integrated health care organizations. Inadequate risk factor control was classified as LDL-C ≥100 mg/dL, A1C ≥7% (53 mmol/mol), BP ≥140/90 mm Hg, or smoking. Major CV events were based on primary hospital discharge diagnoses for myocardial infarction (MI) and acute coronary syndrome (ACS), stroke, or heart failure (HF). Five-year incidence rates, rate ratios, and average attributable fractions were estimated using multivariable Poisson regression models.
  
  
  RESULTS
  Mean (SD) age at baseline was 59 (14) years; 48% of subjects were female, 45% were white, and 31% had CVD. Mean follow-up was 59 months. Event rates per 100 person-years for adults with diabetes and CVD versus those without CVD were 6.0 vs. 1.7 for MI/ACS, 5.3 vs. 1.5 for stroke, 8.4 vs. 1.2 for HF, 18.1 vs. 40 for all CV events, and 23.5 vs. 5.0 for all-cause mortality. The percentages of CV events and deaths associated with inadequate risk factor control were 11% and 3%, respectively, for those with CVD and 34% and 7%, respectively, for those without CVD.
  
  
  CONCLUSIONS
  Additional attention to traditional CV risk factors could yield further substantive reductions in CV events and mortality in adults with diabetes.
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, MN gabriela.x.vazquezbenitez@healthpartners.com.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Vazquez-Benitez
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, MN.
authors.forename: Jay R
authors.initials: JR
authors.lastname: Desai
authors.affiliation: Kaiser Permanente Institute for Health Research, Denver, CO.
authors.forename: Stanley
authors.initials: S
authors.lastname: Xu
authors.affiliation: Kaiser Permanente Institute for Health Research, Denver, CO.
authors.forename: Glenn K
authors.initials: GK
authors.lastname: Goodrich
authors.affiliation: Kaiser Permanente Institute for Health Research, Denver, CO.
authors.forename: Emily B
authors.initials: EB
authors.lastname: Schroeder
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, OR.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Nichols
authors.affiliation: Johns Hopkins Medicine, Baltimore, MD.
authors.forename: Jodi
authors.initials: J
authors.lastname: Segal
authors.affiliation: Kaiser Permanente Georgia, Center for Health Research Southeast, Atlanta, GA.
authors.forename: Melissa G
authors.initials: MG
authors.lastname: Butler
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
authors.affiliation: Kaiser Permanente Institute for Health Research, Denver, CO.
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
authors.affiliation: Group Health Research Institute, Seattle, WA.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Newton
authors.affiliation: University of Washington School of Medicine, Seattle, WA.
authors.forename: Leo S
authors.initials: LS
authors.lastname: Morales
authors.affiliation: Department of Endocrinology, Marshfield Clinic, Marshfield, WI.
authors.forename: Ram D
authors.initials: RD
authors.lastname: Pathak
authors.affiliation: Lutheran Medical Center, Brooklyn, NY.
authors.forename: Abraham
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
authors.forename: Kristi
authors.initials: K
authors.lastname: Reynolds
authors.affiliation: Geisinger Health System, Danville, PA.
authors.forename: H Lester
authors.initials: HL
authors.lastname: Kirchner
authors.affiliation: Kaiser Permanente Center for Health Research, Honolulu, HI.
authors.forename: Beth
authors.initials: B
authors.lastname: Waitzfelder
authors.affiliation: Lutheran Medical Center, Brooklyn, NY Virginia Commonwealth University School of Medicine, Richmond, VA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Elston Lafata
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, MN.
authors.forename: Renuka
authors.initials: R
authors.lastname: Adibhatla
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, MN.
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Xu
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, MN.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: O'Connor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination; D002423:Cause of Death; D008078:Cholesterol, LDL / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D003925:Diabetic Angiopathies / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006333:Heart Failure / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000150:complications; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000401:mortality; D020521:Stroke / Q000401:mortality; D014481:United States; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin