Depressive symptoms, serious psychological distress, diabetes distress and cardiovascular risk factor control in patients with type 2 diabetes

Background: Guidelines recommend optimal control of cardiovascular risk factors such as blood pressure, lipids and smoking in addition to glycemic control to reduce the risk of micro and macro-vascular complications in patients with type 2 diabetes mellitus (T2D). However, the extent of comprehensive cardiovascular risk factor control in T2D internationally is not well-known. Methods: A total of 14,169 T2D patients initiating second-line therapy across 37 countries were enrolled in the DISCOVER registry. Optimal cardiovascular risk factor management at study baseline was defined as control of the following risk factors among eligible patients: 1) Systolic BP <140mmHg for all T2D patients; 2) statin prescription in all T2D patients ≥ 40 years, high-intensity statin for those with T2D and ASCVD; 3) non-smoking status for all T2D patients; 4) treatment with ACE-Inhibitor/Angiotensin Receptor Blocker (ACEI/ARB) in patients with T2D and 5) hypertension (HTN)/albuminuria and secondary ASCVD prevention with low-dose aspirin (ASA) in those with T2D and ASCVD. Global and country specific rates of individual and combined risk factor control were calculated. Inter-country variability was estimated using median odds ratios (MOR). Results: Mean age of the DISCOVER cohort was 56.6 (SD= 11.7) years; 7534 (53.2%) were male, mean BMI was 29.6 (SD= 5.9) kg/m 2 , median duration of T2D was 4.1 (IQR 2.0, 7.8) years. A total of 1643 (11.9%) patients had ASCVD, 7221 (51.0%) had HTN and 606 (4.3%) had albuminuria. Overall, among eligible patients, BP was controlled in 67.2% (9043/13457); statin treatment was prescribed in 38.3% (4977/12987); 85.2% (12,075/14169) were not smoking; ACEI/ARB treatment was prescribed in 53.7% (4917/9151), and ASA for secondary prevention was prescribed in 51.6% (847/1643) patients with ASCVD. Of 13,118 patients with 3 or more risk factors, 5312 (40.5%) had optimal control of at least 3 risk factors with wide inter-country variability. Conclusion: In a global registry of individuals with T2D from 37 countries, comprehensive control of ASCVD risk factors was not achieved in most patients, with wide variability among countries. Better strategies are needed to consistently provide comprehensive cardiovascular risk factor control in patients with T2D to improve long term outcomes.

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The effectiveness and cost of single and multi-factorial cardiovascular risk factor modification to guideline targets in type 2 diabetes

Primary Care Diabetes ◽

10.1016/j.pcd.2011.12.001 ◽

2012 ◽

Vol 6 (1) ◽

pp. 67-73 ◽

Cited By ~ 1

Author(s):

A. Prescott ◽

J.E. Bailey ◽

K.J. Kelly ◽

T. Munyombwe ◽

A. Gray ◽

...

Keyword(s):

Type 2 Diabetes ◽

Risk Factor ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factor ◽

Risk Factor Modification ◽

Factor Modification

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Cardiovascular risk factor reduction effective in type 2 diabetes mellitus

Inpharma Weekly ◽

10.2165/00128413-200213240-00025 ◽

2002 ◽

Vol &NA; (1324) ◽

pp. 12

Author(s):

&NA;

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Risk Factor ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factor ◽

Risk Factor Reduction

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Metabolic Syndrome as a Cardiovascular Risk Factor in Patients With Type 2 Diabetes

Revista Española de Cardiología (English Edition) ◽

10.1016/s1885-5857(06)60626-9 ◽

2004 ◽

Vol 57 (6) ◽

pp. 507-513

Author(s):

José A. Gimeno Orna ◽

Luis M. Lou Arnal ◽

Edmundo Molinero Herguedas ◽

Beatriz Boned Julián ◽

Desirée P. Portilla Córdoba

Keyword(s):

Type 2 Diabetes ◽

Metabolic Syndrome ◽

Risk Factor ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factor

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Cardiovascular Benefit of Empagliflozin Across the Spectrum of Cardiovascular Risk Factor Control in the EMPA-REG OUTCOME Trial

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa321 ◽

2020 ◽

Vol 105 (9) ◽

pp. 3025-3035

Author(s):

Silvio E Inzucchi ◽

Kamlesh Khunti ◽

David H Fitchett ◽

Christoph Wanner ◽

Michaela Mattheus ◽

...

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Risk Factor ◽

Cardiovascular Risk ◽

Density Lipoprotein ◽

Baseline Risk ◽

Risk Factor Control ◽

Increased Risk ◽

Outcome Trial

Abstract Context Control of multiple cardiovascular (CV) risk factors reduces CV events in individuals with type 2 diabetes. Objective To investigate this association in a contemporary clinical trial population, including how CV risk factor control affects the CV benefits of empagliflozin, a sodium-glucose cotransporter-2 inhibitor. Design Post hoc analysis. Setting Randomized CV outcome trial (EMPA-REG OUTCOME). Participants Type 2 diabetes patients with established CV disease. Intervention Empagliflozin or placebo. Main Outcome Measures Risk of CV outcomes—including the treatment effect of empagliflozin—by achieving 7 goals for CV risk factor control at baseline: (1) glycated hemoglobin <7.5%, (2) low-density lipoprotein cholesterol <100 mg/dL or statin use, (3) systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg, (4) pharmacological renin-angiotensin-aldosterone system blockade, (5) normoalbuminuria, (6) aspirin use, (7) nonsmoking. Results In the placebo group, the hazard ratio (HR) for CV death was 4.00 (95% CI, 2.26–7.11) and 2.48 (95% CI, 1.52–4.06) for patients achieving only 0–3 or 4–5 risk factor goals at baseline, respectively, compared with those achieving 6–7 goals. Participants achieving 0–3 or 4–5 goals also had increased risk for the composite outcome of hospitalization for heart failure or CV death (excluding fatal stroke) (HR 2.89 [1.82–4.57] and 1.90 [1.31–2.78], respectively) and 3-point major adverse CV events (HR 2.21 [1.53–3.19] and 1.42 [1.06–1.89]). Empagliflozin significantly reduced these outcomes across all risk factor control categories (P > 0.05 for treatment-by-subgroup interactions). Conclusions Cardiovascular risk in EMPA-REG OUTCOME was inversely associated with baseline CV risk factor control. Empagliflozin’s cardioprotective effect was consistent regardless of multiple baseline risk factor control.

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