From the Journals

Studies support cardiovascular risk management in T2DM

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Cardiovascular risk control is ‘essential’

“Given the high prevalence of obesity and the related increase in type 2 diabetes, prevention of cardiovascular complications is essential,” Steven A. Schroeder, MD, wrote in an editorial published along with the studies (N Engl J Med. 2018 Aug 16. doi: 10.1056/NEJMe1809004).

The findings reported by Hu and colleagues demonstrate that “the cardiovascular and overall mortality benefits of stopping smoking far outweigh the risks of acquiring type 2 diabetes,” he wrote.

The results reported by Rawshani and coauthors “provide clear support for active management of risk factors” because of the fact that patients with risk factor variables within recommended range had little or no excess risk of death or cardiovascular events.

The results of these two studies “provide support for control of cardiovascular risk factors in patients with diabetes, as well as reassurance that the benefits of smoking cessation outweigh the risks of obesity-associated diabetes,” he concluded.

Dr. Schroeder is on the faculty of the department of medicine, University of California, San Francisco. He had no financial conflicts of interest to disclose.



The second study, which included 271,174 patients with T2DM from the Swedish National Diabetes Register and 1,355,870 controls, examined five risk factors: elevated glycated hemoglobin level, elevated low-density lipoprotein cholesterol level, albuminuria, smoking, and elevated blood pressure.

All-cause mortality, myocardial infarction, stroke, and hospitalization for heart failure were evaluated. The risk of each outcome among patients with T2DM was estimated according to the number of risk-factor variables within guideline-recommended target ranges, compared with matched controls, wrote Aidin Rawshani, MD, of the department of molecular and clinical medicine at the University of Gothenburg (Sweden), and his coauthors (N Engl J Med. 2018 Aug 16. doi: 10.1056/NEJMoa1800256).

Among the T2DM patients, the excess risk of outcomes was reduced with each risk factor variable within the recommended target range. A total of 37,825 patients with T2DM (13.9%) and 137,520 controls (10.1%) died during the study period.

Among T2DM patients with all variables within target range, the hazard ratio was 1.06 for all-cause death (95% CI, 1.00-1.12); 0.84 for acute myocardial infarction (95% CI, 0.75-0.93); and 0.95 for stroke (95% CI, 0.84-1.07). Smoking was the strongest predictor of death, followed by physical activity, marital status, glycated hemoglobin level, and use of statins.

The study results “indicate that having all five risk-factor variables within the target ranges could theoretically eliminate the excess risk of acute myocardial infarction,” Dr. Rawshani and his colleagues wrote. “Patients with type 2 diabetes who had five risk-factor variables within target ranges appeared to have little or no excess risks of death, myocardial infarction, and stroke as compared with the general population.”

Dr. Hu and his coauthors did not report any disclosures. Dr. Rawshani’s coauthors disclosed relationships with numerous companies including Amgen, Astra Zeneca, and Boehringer Ingelheim.

SOURCE: Hu Y et al. N Engl J Med. 2018 Aug 16. doi: 10.1056/NEJMoa1803626. Rawshani A et al. N Engl J Med. 2018 Aug 16. doi: 10.1056/NEJMoa1800256.


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