The effect of controlling the ABC’s of diabetes on cardiovascular disease in a community-based endocrinology practice

Swarna Varma,Gretchen A Piatt

doi:10.4236/jdm.2013.34031

Abstract

Introduction: Large clinical trials demonstrate that glycemic, blood pressure, and cholesterol control lead to risk reduction in cardiovascular events. We determined whether A1c, blood pressure, and cholesterol control were associated with incident cardiovascular disease [CVD] in a community-based endocrinology practice over 10 years. Methods: 385 consecutive patients seen for diabetes management in a CBEP comprised the analysis cohort. To be included, a patient had ≥2 A1c, blood pressure, and LDLc measurements respectively without prevalent CVD. All patients were 18 years or older with a diagnosis of diabetes before or during calendar year 2000. Results: 17.6% of patients developed incident CVD over 10 years. After controlling for age, gender, and time, patients who improved their A1c to

Highlights

Large clinical trials demonstrate that glycemic, blood pressure, and cholesterol control lead to risk reduction in cardiovascular events
Glycemic control led to a 15% 33% risk reduction in the DCCT and UKPDS trials [2,3,4], while maintaining blood pressure with antiotensin converting enzyme inhibitors or blockers resulted in a 16% 50% risk reduction for cardiovascular events in the ASCOT, LIFE, HOPE and MICROHOPE trials [5,6,7,8]
To investigate the effect of ABC control on incident cardiovascular disease [CVD], we employed a non-randomized, retrospective cohort design, where we identified four hundred consecutive patients seen in consultation for diabetes management in a community-based endocrinology practice, beginning in 2000 and followed through 2009

Summary

Introduction

Large clinical trials demonstrate that glycemic, blood pressure, and cholesterol control lead to risk reduction in cardiovascular events. Patients who achieved all ABCSs at goal level at least once were 2.5x more likely not to develop incident CVD [hazard rate = 2.5, 95% CI: 1.2, 5.1] during their time in the practice. Conclusion: These results highlight the feasibility of achieving A1c, blood pressure, and cholesterol goals and demonstrate the significant impact that control has on incident CVD in a community-based endocrinology practice. Large clinical trials demonstrate that control of glycemic, blood pressure, and lipids [ABCs] leads to risk reduction in cardiovascular events. Despite the evidence for ABC control to reduce the risk of cardiovascular events in large clinical trials, translating these results into real-world clinical practice remains challenging, as demonstrated by national data. Only 12.7% of people with diabetes in the US achieved all ABC goals simultaneously [15]

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