title: Cardiovascular Risk Factor Targets and Cardiovascular Disease Event Risk in Diabetes: A Pooling Project of the Atherosclerosis Risk in Communities Study, Multi-Ethnic Study of Atherosclerosis, and Jackson Heart Study.
abstract: Controlling cardiovascular disease (CVD) risk factors in diabetes mellitus (DM) reduces the number of CVD events, but the effects of multifactorial risk factor control are not well quantified. We examined whether being at targets for blood pressure (BP), LDL cholesterol (LDL-C), and glycated hemoglobin (HbA1c) together are associated with lower risks for CVD events in U.S. adults with DM.
  
  
  
  We studied 2,018 adults, 28-86 years of age with DM but without known CVD, from the Atherosclerosis Risk in Communities (ARIC) study, Multi-Ethnic Study of Atherosclerosis (MESA), and Jackson Heart Study (JHS). Cox regression examined coronary heart disease (CHD) and CVD events over a mean 11-year follow-up in those individuals at BP, LDL-C, and HbA1c target levels, and by the number of controlled risk factors.
  
  
  
  Of 2,018 DM subjects (43% male, 55% African American), 41.8%, 32.1%, and 41.9% were at target levels for BP, LDL-C, and HbA1c, respectively; 41.1%, 26.5%, and 7.2% were at target levels for any one, two, or all three factors, respectively. Being at BP, LDL-C, or HbA1c target levels related to 17%, 33%, and 37% lower CVD risks and 17%, 41%, and 36% lower CHD risks, respectively (P < 0.05 to P < 0.0001, except for BP in CHD risk); those subjects with one, two, or all three risk factors at target levels (vs. none) had incrementally lower adjusted risks of CVD events of 36%, 52%, and 62%, respectively, and incrementally lower adjusted risks of CHD events of 41%, 56%, and 60%, respectively (P < 0.001 to P < 0.0001). Propensity score adjustment showed similar findings.
  
  
  
  Optimal levels of BP, LDL-C, and HbA1c occurring together in individuals with DM are uncommon, but are associated with substantially lower risk of CHD and CVD.
authors.affiliation: Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA ndwong@uci.edu.
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Wong
authors.affiliation: Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Yanglu
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA.
authors.forename: Rohini
authors.initials: R
authors.lastname: Patel
authors.affiliation: Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Patao
authors.affiliation: Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA.
authors.forename: Shaista
authors.initials: S
authors.lastname: Malik
authors.affiliation: Department of Epidemiology & Prevention, Wake Forest University, Winston-Salem, NC.
authors.forename: Alain G
authors.initials: AG
authors.lastname: Bertoni
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Correa
authors.affiliation: Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN.
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.affiliation: Health Economics and Outcomes Research, Bristol-Myers Squibb, Wallingford, CT.
authors.forename: Sumesh
authors.initials: S
authors.lastname: Kachroo
authors.affiliation: Health Economics and Outcomes Research, Bristol-Myers Squibb, Wallingford, CT.
authors.forename: Jayanti
authors.initials: J
authors.lastname: Mukherjee
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
authors.forename: Herman
authors.initials: H
authors.lastname: Taylor
authors.affiliation: Department of Epidemiology, Johns Hopkins University, Baltimore, MD.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology*; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin