Risk Factors, Mortality, and Cardiovascular Outcomes in Patients with Type 2 Diabetes

Rawshani, Aidin; Rawshani, Araz; Franzén, Stefan; Sattar, Naveed; Eliasson, Björn; Svensson, Ann Marie; Zethelius, Björn; Miftaraj, Mervete; McGuire, Darren K.; Rosengren, Annika; Guðbjörnsdóttir, Soffia

doi:10.1056/nejmoa1800256

Cited by 981 publications

(748 citation statements)

References 21 publications

(16 reference statements)

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“…In another cohort study comprising 11 431 patients with DM and CKD from a primary care database in the UK with linked inpatient and mortality data, those who were at HbA1c target of < 53 mmol/mol (7%), BP target of <140/90 mmHg and total cholesterol target of <5 mmol/L, and who had non‐smoking status (37% and 13% met three or four criteria, respectively) had 40% lower risks for both all‐cause and cardiovascular mortality, along with 27% lower risks for CHD and 37% lower risks for stroke . Most recently, in a report from 271 174 patients in the Swedish National Diabetes Register, the group that was at target with regard to five major risk factors (HbA1c, LDL cholesterol, BP, albuminuria and smoking) was at the same risk of all‐cause mortality, myocardial infarction and stroke as a matched control group; there was only an excess risk of hospitalization for heart failure …”

Section: Discussionmentioning

confidence: 96%

Composite cardiovascular risk factor target achievement and its predictors in US adults with diabetes: The Diabetes Collaborative Registry

Fan

Song

Inzucchi

et al. 2019

Diabetes Obesity Metabolism

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Aim To investigate multiple risk factor target attainment in adults with diabetes mellitus (DM) for atherosclerotic cardiovascular disease (ASCVD) prevention and the predictors of such attainment in a contemporary DM registry. Methods In the US Diabetes Collaborative Registry we identified patients who were at target for glycated haemoglobin (HbA1c; < 53 mmol/mol (7%) or < 64 mmol/mol (8%) if with ASCVD), LDL cholesterol (< 2.6 mmol/L (100 mg/dL) or < 1.8 mmol/L (70 mg/dL) 1.8 if with ASCVD) and blood pressure (BP; <140/90 mmHg and < 130/80 mmHg as an alternate), and who had non‐smoking status, by sex, race and history of ASCVD. Multiple logistic regression was used to examine predictors of target attainment. Results In 74 393 patients with DM who had available data (mean age 69.0 years, 41.0% women), overall target attainment for HbA1c, BP, LDL cholesterol and non‐smoking status was 73.6%, 69.0% (40.3% for BP <130/80 mmHg), 48.6% and 85.2%, respectively. Only 21.6% (13.0% with BP <130/80 mmHg) were at target for all four measures, and the proportions were higher in men (23.6%) versus women (18.6%) and in white people (22.5%) versus African‐American people (14.7%) and people of other races (20.8%; P < 0.01). A total of 62.4% were on a moderate‐/high‐intensity statin. Age (≥65 years: odds ratio [OR] 1.9, 95% confidence interval [CI] 1.7‐2.0; and 55‐64 years: OR 1.3, 95% CI 1.2‐1.4 vs. <55 years), male sex (OR 1.3, 95% CI 1.3‐1.4), white race (OR 1.4, 95% CI 1.3‐1.5), middle or high income (ORs 1.1, 95% CI 1.1‐1.2 or 1.4, 95% CI 1.4‐1.5, respectively) were associated, and depression (OR 0.9, 95% CI 0.8‐1.0) was inversely associated with meeting all four targets (all P = 0.01 to P < 0.001). Conclusions In our US registry of patients with DM, only one in five patients were achieving comprehensive risk factor control. Multifactorial interventions will be necessary to optimize ASCVD risk factor control.

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Section: Discussionmentioning

confidence: 96%

Composite cardiovascular risk factor target achievement and its predictors in US adults with diabetes: The Diabetes Collaborative Registry

Fan

Song

Inzucchi

et al. 2019

Diabetes Obesity Metabolism

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“…Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease characterized by insulin resistance and a progressive dysfunction of the pancreatic β‐cells. Patients with T2DM have increased risks of death and cardiovascular events when compared to the general population, but only when additional risk factors are present . One additional risk factor often seen in diabetic patients and that contributes to their elevated cardiovascular risk is dyslipidaemia ( see for more details: K. Ray and H. Gonna in this Special Supplement).…”

Section: Diabetic Dyslipidaemia: Characteristics and Current Managementmentioning

confidence: 99%

Efficacy and safety of proprotein convertase subtilisin/kexin 9 inhibitors in people with diabetes and dyslipidaemia

Dijk

Cariou

2019

Diabetes Obesity Metabolism

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Diabetic dyslipidaemia, characterized by quantitative, qualitative and kinetic changes in all major circulating lipids, contributes to the increased cardiovascular risk in patients with type 2 diabetes mellitus (T2DM). A promising therapeutic avenue is the inhibition of the proprotein convertase subtilisin kexin 9 (PCSK9) with human monoclonal antibodies (mAbs) that potently reduce plasma low‐density lipoprotein cholesterol (LDL‐C) levels on top of statin treatment. The aim of this review is to evaluate the efficacy of PCSK9 inhibitors to lower the residual cardiovascular risk of T2DM patients and to discuss the safety of PCSK9 inhibition in these patients. PCSK9 inhibitors potently lower plasma LDL‐C levels in T2DM patients and reduce risk for the development of cardiovascular disease. Anti‐PCSK9 mAbs are generally not more or less effective in T2DM patients compared to a general high‐risk population. Nevertheless, due to their higher cardiovascular risk, the absolute risk reduction of major cardiovascular events is more significant in T2DM patients. This suggests that treatment of T2DM patients with anti‐PCSK9 mAbs could be attractive from a cost‐effectiveness perspective. Treatment with anti‐PCSK9 mAbs did not result in significant treatment‐emergent adverse effects. While genetic studies suggest a potential link between PCSK9 inhibition and glucose homeostasis, anti‐PCSK9 mAbs did not worsen glycaemic control in T2DM patients, but their safety should be verified after a longer‐term follow‐up.

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“…In commenting on DECLARE, Dr Javed Butler (Stony Brook University, Stony Brook, New York) asserted that SGLT2 inhibitors should be used in people with type 2 diabetes (T2D) to reduce heart failure risk, regardless of their effect on the classic three‐point MACE. Supporting this claim was compelling data from a recent Swedish cohort study . Controlling HbA1c, smoking, low‐density lipoprotein cholesterol (LDL‐C), blood pressure, and albuminuria attenuated risk for MI (HR 0.84; 95% CI 0.75‐0.93) and, non‐significantly, stroke (HR 0.95; 95% CI 0.84‐1.07) relative to matched controls without diabetes.…”

Section: American Heart Association Scientific Sessions 2018mentioning

confidence: 99%

“…However, the HR for heart failure hospitalizations remained elevated (HR 1.45; 95% CI 1.34‐1.57), even after managing these other risk factors, suggesting that T2D confers heart failure risk independent of HbA1c, smoking, LDL‐C, blood pressure, and albuminuria. Moreover, once patients with T2D develop heart failure, their mortality risk skyrockets and fewer than 10% survive after 5 years, compared with approximately 80% of those with T2D without heart failure . With this in mind, Dr Butler stated that any therapy indicated for improving heart failure outcomes should be a welcome addition to the diabetes care armamentarium.…”

Section: American Heart Association Scientific Sessions 2018mentioning

confidence: 99%

American Heart Association Scientific Sessions 2018

Kurian

Rentzepis

Carracher

et al. 2019

Journal of Diabetes

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Martin J. Kurian, Peter J. Rentzepis, Ann M. Carracher, and Kelly L. Close are of Close Concerns (http://www.closeconcerns.com), a healthcare information company focused exclusively on diabetes and obesity care. Close Concerns publishes Closer Look, a periodical that brings together news and insights in these areas. Each month, the Journal of Diabetes includes this News feature, in which Kurian, Rentzepis, Carracher, and Close review the latest developments relevant to researchers and clinicians.

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Risk Factors, Mortality, and Cardiovascular Outcomes in Patients with Type 2 Diabetes

Cited by 981 publications

References 21 publications

Composite cardiovascular risk factor target achievement and its predictors in US adults with diabetes: The Diabetes Collaborative Registry

Composite cardiovascular risk factor target achievement and its predictors in US adults with diabetes: The Diabetes Collaborative Registry

Efficacy and safety of proprotein convertase subtilisin/kexin 9 inhibitors in people with diabetes and dyslipidaemia

American Heart Association Scientific Sessions 2018

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