EXAGGERATED CARDIOMETABOLIC RISK FACTORS AND CARDIOVASCULAR DISEASE IN CANADIAN PRIMARY CARE PATIENTS WITH DIABETES AND ABDOMINAL OBESITY

Abstract

BackgroundAbdominal obesity is associated with an increased risk of cardiovascular disease (CVD) and diabetes. This cross-sectional study evaluated the prevalence and the management of cardiometabolic risk factors (CMRFs) in overweight/obese subjects with or without diabetes, who were recruited by 468 primary care physicians across Canada.MethodsIn addition to BMI >27 kg/m2 or high waist circumference (WC>94 cm in men, >80 cm in women), the following CMRFs were also assessed in 10,488 subjects: hypertension (systolic > 140, diastolic >90); dysglycemia (IGT or diabetes by CDA criteria); high-density lipoprotein-cholesterol (HDL-C, <1.0 in men or <1.3 mmol/L in women); triglycerides >1.7 mmol/L; LDL-C >3.5 or >2 mmol/L with cardiovascular event; and smoking status.ResultsOf the 9,985 subjects (37% from Ontario, 28% from Québec, 35% from other provinces) analyzed, 3398 had diabetes (34%, 55% men and 45% women). The mean age (60.5 vs. 56.5 years), body weight (97 vs. 92.2 kg) and body mass index (34.8 vs. 33 kg/m2), were higher in the diabetes vs. nondiabetic subjects, respectively. 77% of diabetes subjects were taking oral glucose-lowering drugs and 18% were taking insulin, with a mean fasting glucose of 7.8 mmol/L, and mean hemoglobin A1C of 7.13%. 59% of them had A1C higher than the CDA guideline target of 7% or less. More CMRFs were reported in the diabetes subjects, with an average of 4.6 vs. 2.6. People with diabetes were 10-fold more likely to have ≥5 additional CMRFs (59.6% vs. 5.6%, respectively), and fewer of them had ≤2 additional CMRFs (3.1% vs. 44.3%). 94% of diabetes subjects had increased LDL-C, hypertriglyceridemia and hypertension were more common than nondiabetic subjects (90% vs. 59% and 81% vs. 54%, respectively). Coronary artery disease (19% vs. 10%), peripheral artery disease (7% vs. 2%) and severe renal impairment (3% vs. 0.4%) were also more common. Smoking status and prevalence of depression were similar in both diabetes and nondiabetic groups. A greater proportion of diabetes subjects were taking statins for dyslipidemia (76% vs. 35%) and antihypertensive drugs (78% vs. 50%) but many did not achieve guideline target values (51% with LDL-C>2mmol/L and 40% with SBP/DBP >120/80).ConclusionOverweight/obese people with diabetes in primary care have more CMRFs and CVD than nondiabetic subjects, and require more intensive management to reduce their cardiovascular disease and mortality. BackgroundAbdominal obesity is associated with an increased risk of cardiovascular disease (CVD) and diabetes. This cross-sectional study evaluated the prevalence and the management of cardiometabolic risk factors (CMRFs) in overweight/obese subjects with or without diabetes, who were recruited by 468 primary care physicians across Canada. Abdominal obesity is associated with an increased risk of cardiovascular disease (CVD) and diabetes. This cross-sectional study evaluated the prevalence and the management of cardiometabolic risk factors (CMRFs) in overweight/obese subjects with or without diabetes, who were recruited by 468 primary care physicians across Canada. MethodsIn addition to BMI >27 kg/m2 or high waist circumference (WC>94 cm in men, >80 cm in women), the following CMRFs were also assessed in 10,488 subjects: hypertension (systolic > 140, diastolic >90); dysglycemia (IGT or diabetes by CDA criteria); high-density lipoprotein-cholesterol (HDL-C, <1.0 in men or <1.3 mmol/L in women); triglycerides >1.7 mmol/L; LDL-C >3.5 or >2 mmol/L with cardiovascular event; and smoking status. In addition to BMI >27 kg/m2 or high waist circumference (WC>94 cm in men, >80 cm in women), the following CMRFs were also assessed in 10,488 subjects: hypertension (systolic > 140, diastolic >90); dysglycemia (IGT or diabetes by CDA criteria); high-density lipoprotein-cholesterol (HDL-C, <1.0 in men or <1.3 mmol/L in women); triglycerides >1.7 mmol/L; LDL-C >3.5 or >2 mmol/L with cardiovascular event; and smoking status. ResultsOf the 9,985 subjects (37% from Ontario, 28% from Québec, 35% from other provinces) analyzed, 3398 had diabetes (34%, 55% men and 45% women). The mean age (60.5 vs. 56.5 years), body weight (97 vs. 92.2 kg) and body mass index (34.8 vs. 33 kg/m2), were higher in the diabetes vs. nondiabetic subjects, respectively. 77% of diabetes subjects were taking oral glucose-lowering drugs and 18% were taking insulin, with a mean fasting glucose of 7.8 mmol/L, and mean hemoglobin A1C of 7.13%. 59% of them had A1C higher than the CDA guideline target of 7% or less. More CMRFs were reported in the diabetes subjects, with an average of 4.6 vs. 2.6. People with diabetes were 10-fold more likely to have ≥5 additional CMRFs (59.6% vs. 5.6%, respectively), and fewer of them had ≤2 additional CMRFs (3.1% vs. 44.3%). 94% of diabetes subjects had increased LDL-C, hypertriglyceridemia and hypertension were more common than nondiabetic subjects (90% vs. 59% and 81% vs. 54%, respectively). Coronary artery disease (19% vs. 10%), peripheral artery disease (7% vs. 2%) and severe renal impairment (3% vs. 0.4%) were also more common. Smoking status and prevalence of depression were similar in both diabetes and nondiabetic groups. A greater proportion of diabetes subjects were taking statins for dyslipidemia (76% vs. 35%) and antihypertensive drugs (78% vs. 50%) but many did not achieve guideline target values (51% with LDL-C>2mmol/L and 40% with SBP/DBP >120/80). Of the 9,985 subjects (37% from Ontario, 28% from Québec, 35% from other provinces) analyzed, 3398 had diabetes (34%, 55% men and 45% women). The mean age (60.5 vs. 56.5 years), body weight (97 vs. 92.2 kg) and body mass index (34.8 vs. 33 kg/m2), were higher in the diabetes vs. nondiabetic subjects, respectively. 77% of diabetes subjects were taking oral glucose-lowering drugs and 18% were taking insulin, with a mean fasting glucose of 7.8 mmol/L, and mean hemoglobin A1C of 7.13%. 59% of them had A1C higher than the CDA guideline target of 7% or less. More CMRFs were reported in the diabetes subjects, with an average of 4.6 vs. 2.6. People with diabetes were 10-fold more likely to have ≥5 additional CMRFs (59.6% vs. 5.6%, respectively), and fewer of them had ≤2 additional CMRFs (3.1% vs. 44.3%). 94% of diabetes subjects had increased LDL-C, hypertriglyceridemia and hypertension were more common than nondiabetic subjects (90% vs. 59% and 81% vs. 54%, respectively). Coronary artery disease (19% vs. 10%), peripheral artery disease (7% vs. 2%) and severe renal impairment (3% vs. 0.4%) were also more common. Smoking status and prevalence of depression were similar in both diabetes and nondiabetic groups. A greater proportion of diabetes subjects were taking statins for dyslipidemia (76% vs. 35%) and antihypertensive drugs (78% vs. 50%) but many did not achieve guideline target values (51% with LDL-C>2mmol/L and 40% with SBP/DBP >120/80). ConclusionOverweight/obese people with diabetes in primary care have more CMRFs and CVD than nondiabetic subjects, and require more intensive management to reduce their cardiovascular disease and mortality. Overweight/obese people with diabetes in primary care have more CMRFs and CVD than nondiabetic subjects, and require more intensive management to reduce their cardiovascular disease and mortality.