Gabriela Vazquez-Benitez , 1 , Jay R. Desai 1 , Stanley Xu 2 , Glenn K. Goodrich 2 , Emily B. Schroeder 2 , Gregory A. Nichols 3 , Jodi Segal 4 , Melissa G. Butler 5 , Andrew J. Karter 6 , John F. Steiner 2 , Katherine M. Newton 7 , Leo S. Morales 8 , Ram D. Pathak 9 , Abraham Thomas 10 , Kristi Reynolds 11 , H. Lester Kirchner 12 , Beth Waitzfelder 13 , Jennifer Elston Lafata 10 , 14 , Renuka Adibhatla 1 , Zhiyuan Xu 1 , Patrick J. O’Connor 1
20 February 2015
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.
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.
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.