MedicalResearch.com Interview with:
Dr Araz Rawshani, PhD
Department of Molecular and Clinical Medicine
Institute of Medicine
University of Gothenburg
MedicalResearch.com: What is the background for this study?
Response: Patients with type 2 diabetes have 2 to 4 times greater risk for death and cardiovascular events compared to the general population. There are several randomized trails that encourage a range of interventions that target traditional and modifiable risk factors, such as elevated levels for glycated hemoglobin, blood pressure and low-density lipoprotein cholesterol to reduce the risk for complications of type 2 diabetes. However, there are few randomized trails that have investigated the effects of multifactorial risk factor intervention in reducing the risk for death and cardiovascular events, as compared to patients that are treated with usual care.
We set out to investigate the extent to which the excess risk associated with type 2 diabetes may be mitigated or potentially eliminated by means of evidence-based treatment and multifactorial risk factor modification. In addition, we estimated the relative importance between various risk factors and the incremental risk of death and cardiovascular events associated with diabetes. Furthermore, we investigated the association between glycated hemoglobin, systolic blood pressure and low-density lipoprotein cholesterol (LDL-C) within evidence based target ranges and the abovementioned outcomes.
MedicalResearch.com: What are the main findings?
Response: Our analysis shows that patients with type 2 diabetes that attained all 5 selected risk factors within therapeutic target range had, at most, marginally higher risks of death, stroke and myocardial infarction compared to the general population. The analyses suggest that having all risk factors within target ranges could theoretically eliminate the excess risk for myocardial infarction in patients with type 2 diabetes. The risk of hospitalization for heart failure was greatest out of all outcomes among patients with diabetes.
We identified a stepwise increase in risk of outcomes for each risk factor that was not within target range. Also, young individuals (<55 years of age) with type 2 diabetes had the highest risk for outcomes, suggesting that there may be greater gains from more aggressive treatment in younger patients with diabetes. Low physical activity, smoking, glycated hemoglobin, systolic blood pressure and LDL-C were considered the strongest predictors for outcomes and death. We also found that lower levels of glycated hemoglobin, LDL-C and systolic blood pressure than contemporary therapeutic target levels were associated with lower risk for outcomes.
MedicalResearch.com: What should readers take away from your report?
Response: Multifactorial risk factor intervention appears to substantially reduce the excess risk for cardiovascular events and death. Patients with optimal risk factor control had marginally increased risk for outcomes and could theoretically eliminate the excess risk for acute myocardial infarction. Our results suggest that patients with type 2 diabetes have the greatest risk for heart failure irrespective of the number of risk factors attained within target range. Glycated hemoglobin is the strongest predictor for myocardial infarction and stroke, whereas smoking was the strongest predictor for death. We observed a monotonic relationship among younger age, increasing number of variables not within therapeutic target levels, and a higher risk of cardiovascular outcomes and death.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: The authors believe heart failure is an emerging cardiovascular complication among patients with diabetes. Our study reveals the relative prognostic importance of glycated hemoglobin for incremental risk for heart failure. Further studies are warranted to describe the mechanisms behind elevated glycated hemoglobin that contribute to heart failure.
Considering our findings of lower risk, in patients with type 2 diabetes, with lower levels of glycated hemoglobin, blood pressure and LDL-C than target levels, the authors believe that more randomized trails will attempt to evaluate the optimal level for these risk factors.
Disclosures: I have nothing to disclose.
Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study
Araz Rawshani, PhD, Prof Naveed Sattar, FMedSci
Ann-Marie Svensson, PhD
Prof Björn Eliasson, PhD
Prof Soffia Gudbjörnsdottir, PhD et al
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