Considerably decreased risk of cardiovascular disease with combined reductions in HbA1c, blood pressure and blood lipids in type 2 diabetes: Report from the Swedish National Diabetes Register

Abstract

Objectives: Assess the effect of risk factors changes on risk for cardiovascular disease and mortality in patients with type 2 diabetes selected from the Swedish National Diabetes Register. Methods: Observational study of 13,477 females and males aged 30-75 years, with baseline HbA1c 41-67 mmol/mol, systolic blood pressure 122-154 mmHg and ratio non-HDL:HDL 1.7-4.1, followed for mean 6.5 years until 2012. Four groups were created: a reference group (n = 6757) with increasing final versus baseline HbA1c, systolic blood pressure and non-HDL:HDL cholesterol during the study period, and three groups with decreasing HbA1c (n = 1925), HbA1c and systolic blood pressure (n = 2050) or HbA1c and systolic blood pressure and non-HDL:HDL (n = 2745). Results: Relative risk reduction for fatal/nonfatal cardiovascular disease was 35% with decrease in HbA1c only (mean 6 to final 49 mmol/mol), 56% with decrease in HbA1c and systolic blood pressure (mean 12 to final 128 mmHg) and 75% with combined decreases in HbA1c, systolic blood pressure and non-HDL:HDL (mean 0.8 to final 2.1), all p < 0.001 adjusting for clinical characteristics, other risk factors, treatments and previous cardiovascular disease. Similar risk reductions were found for fatal/nonfatal coronary heart disease, fatal cardiovascular disease, all-cause mortality and also in a subgroup of 3038 patients with albuminuria. Conclusion: Considerable risk reductions for cardiovascular disease and mortality were seen with combined long-term risk factor improvement.

The Dapagliflozin And Prevention of Adverse‐outcomes in Heart Failure (DAPA‐HF) trial: baseline characteristics

“…26,32 About a fifth of patients with type 2 diabetes were not treated with pharmacological glucose-lowering therapy in other registries, diabetes trials and HF studies. [34][35][36] There are few detailed descriptions of the classes of oral glucose-lowering therapies prescribed for patients with HFrEF but in the reports available, the pattern is similar to what we observed in DAPA-HF -with metformin, sulfonylureas and DPP-4 inhibitors accounting for the large majority of these. However, what was different among the studies was the fraction of patients treated with insulin, which varied in the prior reports from 44% in the USA to 24% in Asia; in PARADIGM-HF the proportion was 25% and in SHIFT 32%.…”

“…Specifically, in the ESC Long‐Term Registry, 28% of patients were not receiving glucose‐lowering therapy and in the US/Asian cohort study mentioned earlier, 30–40% of patients with HFrEF were not receiving glucose‐lowering treatment, similar to the percentage in PARADIGM‐HF . About a fifth of patients with type 2 diabetes were not treated with pharmacological glucose‐lowering therapy in other registries, diabetes trials and HF studies . There are few detailed descriptions of the classes of oral glucose‐lowering therapies prescribed for patients with HFrEF but in the reports available, the pattern is similar to what we observed in DAPA‐HF – with metformin, sulfonylureas and DPP‐4 inhibitors accounting for the large majority of these.…”

Are general practitioners characteristics associated with the quality of type 2 diabetes care in general practice? Results from the Norwegian ROSA4 study from 2014

“…Type 2 diabetes (T2DM) increases the risk of coronary heart disease (CHD) and often coexists with hypertension and dyslipidemia which add additional risk for cardiovascular complications and mortality [ 1 , 2 ]. When multiple risk factors such as life style factors, hyperglycaemia, hypertension and dyslipidemia are addressed simultaneously, vascular complications can be reduced [ 3 , 4 ].…”

Type 2 diabetes in general practice in Norway 2005–2014: moderate improvements in risk factor control but still major gaps in complication screening

“… 10 11 A Swedish observational study with 13 000 patients with type 2 diabetes from general practice in 2012 reported that fatal and non-fatal cardiovascular disease (CVD) decreased from 23.6% to 6.0% when they compared patients achieving a decrease versus an increase in hemoglobin A1c (HbA1c), blood pressure and lipids. 4 It has also been shown that early detection of complications by systematic screening and intervention prevents or delays the development of target organ disease. 12 13 …”