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Effect of tight control of HbA1c and blood pressure on cardiovascular diseases in type 2 diabetes: An observational study from the Swedish National Diabetes Register (NDR)

Cederholm, Jan; Zethelius, Bjorn; Nilsson, Peter LU ; Eeg-Olofsson, Katarina; Eliasson, Bjorn and Gudbjornsdottir, Soffia (2009) In Diabetes Research and Clinical Practice 86(1). p.74-81
Abstract
Aim: To estimate hazard ratio (HR) of first incident fatal/non-fatal cardiovascular diseases (CVD) in female/male type 2 diabetic patients, with tight versus adverse control of HbA1c and blood pressure (BP) at baseline, age 30-70 years, no baseline CVD, followed for mean 5.7 years. Methods: 2593 patients with tight control of HbA1c <7.5% and BP <= 140/90 mmHg (median 6.5%/130/80 mmHg), and 2160 patients with adverse control 7.5-9.0%/141-190/91-110 mmHg (median 8.1%/155/85 mmHg). Results: The hazard ratio (HR) for CVD with tight/adverse control was 0.67 (0.55-0.80; p < 0.001), adjusting for age, sex, duration, hypoglycaemic treatment, smoking, BMI, lipid-lowering drugs, antihypertensive drugs, microalbuminuria. Adjusted HR for... (More)
Aim: To estimate hazard ratio (HR) of first incident fatal/non-fatal cardiovascular diseases (CVD) in female/male type 2 diabetic patients, with tight versus adverse control of HbA1c and blood pressure (BP) at baseline, age 30-70 years, no baseline CVD, followed for mean 5.7 years. Methods: 2593 patients with tight control of HbA1c <7.5% and BP <= 140/90 mmHg (median 6.5%/130/80 mmHg), and 2160 patients with adverse control 7.5-9.0%/141-190/91-110 mmHg (median 8.1%/155/85 mmHg). Results: The hazard ratio (HR) for CVD with tight/adverse control was 0.67 (0.55-0.80; p < 0.001), adjusting for age, sex, duration, hypoglycaemic treatment, smoking, BMI, lipid-lowering drugs, antihypertensive drugs, microalbuminuria. Adjusted HR for myocardial infarction, coronary heart disease, stroke and total mortality were 0.72 (0.56-0.92; p = 0.01), 0.69 (0.55-0.86; p < 0.001), 0.62 (0.45-0.84; p < 0.001), 1.00 (0.72-1.39). The partial population-attributable risk percent for myocardial infarction, stroke and CVD was 23%, 33%, 29% if adverse HbA1c/BP control could be avoided, while 43%, 38%, 39% with overweight and smoking also avoided. Baseline lower BMI and absence of microalbuminuria were associated with tight control. Conclusion: Median difference of HbA1c/BP 1.6%/25/5 mmHg between tight and adverse control considerably reduced the risk of cardiovascular diseases. The findings call for a multi-factorial approach to improve HbA1c, BP, obesity, smoking, and microalbuminuria. (C) 2009 Elsevier Ireland Ltd. All rights reserved. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
infarction, Myocardial, Cardiovascular diseases, Diabetes, Blood pressure, Stroke
in
Diabetes Research and Clinical Practice
volume
86
issue
1
pages
74 - 81
publisher
Elsevier
external identifiers
  • wos:000270769700012
  • scopus:69849089051
ISSN
1872-8227
DOI
10.1016/j.diabres.2009.07.003
language
English
LU publication?
yes
id
7c343b68-4bce-4813-b86f-b826f246e6b1 (old id 1506982)
date added to LUP
2009-11-23 13:28:35
date last changed
2017-03-05 03:37:14
@article{7c343b68-4bce-4813-b86f-b826f246e6b1,
  abstract     = {Aim: To estimate hazard ratio (HR) of first incident fatal/non-fatal cardiovascular diseases (CVD) in female/male type 2 diabetic patients, with tight versus adverse control of HbA1c and blood pressure (BP) at baseline, age 30-70 years, no baseline CVD, followed for mean 5.7 years. Methods: 2593 patients with tight control of HbA1c &lt;7.5% and BP &lt;= 140/90 mmHg (median 6.5%/130/80 mmHg), and 2160 patients with adverse control 7.5-9.0%/141-190/91-110 mmHg (median 8.1%/155/85 mmHg). Results: The hazard ratio (HR) for CVD with tight/adverse control was 0.67 (0.55-0.80; p &lt; 0.001), adjusting for age, sex, duration, hypoglycaemic treatment, smoking, BMI, lipid-lowering drugs, antihypertensive drugs, microalbuminuria. Adjusted HR for myocardial infarction, coronary heart disease, stroke and total mortality were 0.72 (0.56-0.92; p = 0.01), 0.69 (0.55-0.86; p &lt; 0.001), 0.62 (0.45-0.84; p &lt; 0.001), 1.00 (0.72-1.39). The partial population-attributable risk percent for myocardial infarction, stroke and CVD was 23%, 33%, 29% if adverse HbA1c/BP control could be avoided, while 43%, 38%, 39% with overweight and smoking also avoided. Baseline lower BMI and absence of microalbuminuria were associated with tight control. Conclusion: Median difference of HbA1c/BP 1.6%/25/5 mmHg between tight and adverse control considerably reduced the risk of cardiovascular diseases. The findings call for a multi-factorial approach to improve HbA1c, BP, obesity, smoking, and microalbuminuria. (C) 2009 Elsevier Ireland Ltd. All rights reserved.},
  author       = {Cederholm, Jan and Zethelius, Bjorn and Nilsson, Peter and Eeg-Olofsson, Katarina and Eliasson, Bjorn and Gudbjornsdottir, Soffia},
  issn         = {1872-8227},
  keyword      = {infarction,Myocardial,Cardiovascular diseases,Diabetes,Blood pressure,Stroke},
  language     = {eng},
  number       = {1},
  pages        = {74--81},
  publisher    = {Elsevier},
  series       = {Diabetes Research and Clinical Practice},
  title        = {Effect of tight control of HbA1c and blood pressure on cardiovascular diseases in type 2 diabetes: An observational study from the Swedish National Diabetes Register (NDR)},
  url          = {http://dx.doi.org/10.1016/j.diabres.2009.07.003},
  volume       = {86},
  year         = {2009},
}