Control Of Cardiovascular Risk Factors Research Articles

Significance of Insignificant Left Main Disease

Significance of Insignificant Left Main Disease

Effectiveness of a self-management education program on hypertension control and contributing factors in older adults: an interventional trial

Background: One of the common disorders that may negatively affect the health status in elderly is hypertension. Self-management education offers an effective method to control various disorders. This study was designed to assess the effectiveness of self-management educational program on blood pressure, and other cardiometabolic risk factors control among elderly patients from Tabriz, Iran. Material and methods: 227 eligible hypertensive elderly patients from three primary health care centers of Tabriz participated in 12 sessions of self-management education intervention conducted in 6 months from April to October 2019. Systolic (SBP) and diastolic blood pressure (DBP), serum levels of fasting blood sugar (FBS), total cholesterol (TC), and triglyceride, as well as anthropometric indices were assessed both before and at the end of the intervention. Results: The participants were 64.5 ± 5.8 years of age (mean ± SD). After 6-month attendance in educational sessions, the SBP (p = 0.04), body weight (p = 0.01), body mass index (BMI) (p = 0.02), FBS (p = 0.01), and TC (p < 0.0001) were lower as referred to baseline. Conclusion: Study suggests self-management education programs in elderly may be beneficial for cardiovascular risk factors control.

Death and cardiovascular outcomes in end-stage renal failure patients on different modalities of dialysis

Cardiovascular morbidity and mortality in end-stage renal failure (ESRF) patients are high. We examined the incidence and predictors of death and acute myocardial infarction (AMI) in ESRF patients on different modalities of dialysis. Data were obtained from a population-based database (National Registry Disease Offices) in Singapore. The study cohort comprised all adult patients initiated on dialysis between 2007 and 2012 who were closely followed for the development of death and AMI until September 2014. Cox regression methods were used to identify predictors of death and AMI. Of 5,309 patients, 4,449 were on haemodialysis and 860 on peritoneal dialysis (PD). Mean age of the cohort was 61 (±13) years (44% women), of Chinese (67%), Malay (25%) and Indian (7%) ethnicities. By September 2014, the incidence of all-cause death was 34%; close to a third of the patients died from a cardiovascular cause. Age >60 years and the presence of ischaemic heart disease, diabetes, stroke, peripheral vascular disease and PD were identified as independent predictors of all-cause death. PD patients had lower odds of survival compared to patients on haemodialysis (hazard ratio 1.51, 95% confidence interval 1.35-1.70, P<0.0001). Predictors of AMI in this cohort were older age (>60 years) and the presence of ischaemic heart disease, diabetes, stroke, peripheral vascular disease and current/ex-smokers. There were no significant differences in the incidence of AMI between patients on PD and haemodialysis. The short-term incidence of death and AMI remains high in Singapore. Future studies should investigate the benefits of a tighter control of cardiovascular risk factors among ESRF patients on dialysis.

Efficacy of a supervised exercise training program on five-year readmission rates in patients with acute coronary syndrome. A randomised controlled trial

Introduction and objectivesExercise-based cardiac rehabilitation programmes can reduce mortality but their effects on readmission rates are unclear. The primary aim was to evaluate the efficacy of a supervised exercise-based cardiac rehabilitation programme on cardiac readmissions in patients with acute coronary syndrome at five years. MethodsWe conducted an open, controlled, randomized, hospital-based clinical trial. Patients were assigned either to the control group (CG) who received standard care or to the intervention group (IG) who participated in a supervised exercise programme (3h per week of supervised exercise training for 10 weeks). Patients were evaluated at 5 years. ResultsSeventy-six patients [41 CG, 35 IG, mean age 59.2 (SD 10.4), 82.9% men] were included. Cardiac readmission rates at 5 years were 24% in the CG compared to 9% in the IG (p=0.068), and readmission rates for all causes were 42% in the CG and 23% in the IG (p=0.085). Emergency care for cardiac disease was required more frequently in the CG (17% vs 11%, p=0.486). IG patients performed more regular and intensive exercise (62% vs. 33%, p=0.088). In both groups there were significant deterioration in systolic and diastolic blood pressure, body mass index, waist circumference, HbAc1, triglycerides, LDL and diet, and a significant increase in HDL. ConclusionsPatients who participated in the supervised exercise training programme were readmitted less often than controls for cardiac disease and for all causes at 5 years, the reduction was clinically meaningful although not statistically significant. Control of cardiovascular risk factors deteriorated in both groups.

Evaluation of knowledge, barriers, and attitudes in the management of type 2 diabetes in elderly patients: A Delphi study on primary and hospital care

ObjectivesThis work aims to explore attitudes regarding the management of elderly or frail patients with type 2 diabetes mellitus in the routine clinical practice of a multidisciplinary group of physicians in Spain. MethodsA mixed survey was used that included both Delphi and opinion, attitude, and behaviour (OAB) questions. Perceptions in primary care (n = 211) and hospital care (n = 80) were compared. ResultsConsensus was obtained on all statements. Eighty-seven percent of participants considered that severe psychiatric disorders conditioned antidiabetic treatment and 72% that a psychocognitive assessment is as relevant as the assessment of other comorbidities. Hospital care physicians more frequently considered that comorbidity affects self-care (95.0% vs. 82.9%), that a lack of de-intensification is a form of therapeutic inertia (88.8% vs. 76.3%), that classifying older adults as frail is fundamental to choosing targets (96.3% vs. 87.7%), that de-intensification of antidiabetic treatment and control of cardiovascular risk factors should be considered in those over 80 years of age (90.0% vs. 78.7%), and that type 2 diabetes mellitus predisposes patients to sarcopenia (86.3% vs. 71.6%). The usefulness of clinical guidelines was more highly valued among primary care participants (79.1% vs. 72.5%). ConclusionsThere is room for improvement on several aspects of managing elderly or frail patients with type 2 diabetes mellitus, including inertia in treatment de-intensification, conducting a psychocognitive assessment, or the identification of frailty and sarcopenia.

Caracterización clínica y terapéutica de la cardiopatía isquémica en España. Importancia de los programas de rehabilitación cardiaca

Introduction and objectivesThe objective of the study was to characterize the clinical and therapeutic profile of patients with ischemic cardiopathy (IC) in Spain in patients (group 1) at the time of hospital discharge after an acute coronary syndrome (ACS), (group 2) at the first post-discharge follow-up visit, and (group 3) after one year of the ACS. Patients and methodsObservational, multicenter, cross-sectional, nationwide, performed in conditions of routine clinical practice. ResultsA total of 1018 patients were included: 354 (34.8%) in the group 1, 326 (32.0%) in the 2, and 338 (33.2%) in the 3. Compared with group 3, a higher percentage of patients from group 1 were smokers (32.2% versus 10.9%), consumed alcohol (28.2% versus 19.5%), did not do any physical exercise (61.0% versus 38.2%) or followed a diet (57.1% versus 32.5%). Of patients in group 1, 65.4% were referred to a cardiac rehabilitation program (CRP). Of those in group 2, 53.1% had not a scheduled appointment to initiate a CRP. Regarding group 3, 58.3% did not receive the recommendation of doing a CRP. Absence of obesity and attendance to a CRP were variables associated with the control of cardiovascular risk factors. ConclusionsCurrently, less than 50% of patients with IC in Spain are remitted to a CRP despite being associated with an improved control of cardiovascular risk factors.

Relevance of Cardiovascular Risk Factors Screening in People Aged over 65 Years: Results from a Large French Urban Population (The CARVAR92 Study)

Background: Cardiovascular disease is the leading cause of death and disability in older people. Traditional cardiovascular risk factors (CVRFs) still have an impact on cardiovascular risk among older people. Nevertheless, screening campaigns rarely target subjects aged over 65 years. This study aimed to assess the distribution and relevance of conventional CVRF screening in people aged over 65 years. Methods: Between 2007 and 2018, among a screening CVRF campaign in the western suburbs of Paris (32,692 subjects), we individualized 6,577 subjects aged 65 years and over. All conventional CVRFs have been systematically assessed. Results: The screening allowed to suspect hypertension in a larger proportion of subjects over 65 years compared to subjects under 65 years (27% vs. 18%, p < 0.0001). Hypertension control was higher in women compared to men but not significantly different in the age-groups (p = 0.91). Screening for diabetes mellitus was positive in 3% of older subjects and 2.4% in younger (p = 0.005). Risk assessment with dedicated score (SCORE O.P.) allowed to move toward a low-risk estimation, resulting in the diminution of intermediate risk group in women over 65 years (from 68 to 61%, p < 0.001). Conclusions: Screening CVRFs especially hypertension remains relevant in people aged over 65 years as it enables to detect unknown CVRFs in numerous subjects. Increasing awareness of CVRFs may be the first step to CVRF control, which is known to be efficient on cardiovascular mortality and functional autonomy in later life.

Risk factors in developing retinal vein occlusion in subject with obstructive sleep apnea.

Patients with obstructive sleep apnea (OSA) have a higher risk of developing vascular diseases. In this study, we evaluated the clinical profile of patients with OSA who develop retinal vein occlusion (RVO) compared with a population of OSA patients without RVO. We analyzed patients with OSA diagnosed with RVO (21 cases; mean of age 61 years. range 44-87 years. 67% men), belonging to a large cohort of people with long-term follow-up for RVO (up to 12 years). We compared them with 21 patients with OSA, without RVO, matched by age and gender, selected from the Sleep Unit Registry (control group). There were no differences in the prevalence of arterial hypertension (AHT) or Diabetes mellitus (DM), but the RVO patients presented a higher diastolic blood pressure compared to controls (87.6±12.6 mmHg vs. 77.9±10.1 mmHg respectively). The polygraphic parameters were similar in both groups. The Apnea-Hypopnea Index (IHA) similar in both groups (30.4±20.9 RVO vs. 33.7±22.1 controls). In addition, RVO patients had a less favorable lipid profile, with higher total cholesterol (218±52 mg/dL vs. 179±41 mg/dL), higher LDL cholesterol (139±47 mg/dL vs. 107±32 mg/dL) and higher atherogenic indices: LDL/HDL (2.78±0.95 RVO vs. 2.03±0.67 controls) and total cholesterol/HDL (4.37±1.08 vs. 3.45±0.84). Among the cases, 81% had peripheral RVO (superior temporal branch in 20 out of 21 cases) and 19% had central RVO. A percentage of 62% of the cases received intravitreal antiangiogenic therapy and dexamethasone implants and 33% received argon laser photocoagulation. Poor control of cardiovascular risk factors, particularly dyslipidemias, in patients with OSA may lead to the development of this ocular complication.

Expert Insights for PCPs in Managing CKD in T2DM

Diabetic kidney disease (DKD) is the most common cause of end-stage renal disease (ESRD) in most developed countries including Singapore. Patients with DKD have a disproportionately higher risk for cardiovascular (CV) events and mortality. A comprehensive strategy is recommended for management of patients with DKD to reduce the risks of kidney disease progression and CV disease. Lifestyle modification, CV risk factor and glycaemic control, and maximum tolerated renin-angiotensin-aldosterone-system (RAAS) blockade form the foundation of DKD care. The kidney-protective effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors are well established by randomised controlled trials (RTCs) in patients with DKD, and are independent of the stage of kidney disease. Glucagon-like peptide-1 receptor agonist (GLP-1RA) is the preferred added agent to metformin and SGLT-2 inhibitor if individualised glycaemic targets are not achieved. In addition, the non-steroidal mineralocorticoid receptor antagonist (MRA) finerenone improves kidney and cardiovascular outcomes in patients with DKD.

Abstract P190: Health Literacy And Cardiovascular Health: The Multi-Ethnic Study Of Atherosclerosis

Background: Limited health literacy (HL) is associated with individual cardiovascular risk factors and poor risk factor control. The association of HL to composite indices of cardiovascular health (CVH) has not been documented. Hypothesis: Limited HL is associated with suboptimal achievement of ideal CVH as identified by Life’s Simple 7 (LS7). Methods: Included in this analysis are 3766 participants of the Multi-Ethnic Study of Atherosclerosis who completed four HL questionnaire items via follow-up phone calls (2016-2018). Item scores were summed and dichotomized into adequate (≤10) or limited HL (&gt;10). Clinical measures of BMI, total cholesterol, blood pressure, and fasting blood glucose, along with self-reported smoking status, physical activity, and healthy diet were measured at baseline (2000-2002) and categorized by LS7 achievement criteria (poor, inadequate, ideal). LS7 metrics were incorporated into overall CVH (low, medium, high). Poisson regression with robust variance estimation was used to compute prevalence risk ratios and 95% confidence intervals (PRR[95% CI]) of high/medium CVH as well as intermediate/ideal LS7 comparing limited HL to adequate HL. Results: Participants were on average(SD) 59.4(9.13) years old at baseline, 46.0% male, and 58.0% non-white. Prevalence of limited HL was 15.0%. Compared to adequate HL, participants with limited HL were less likely to have medium CVH (0.90[0.84-0.97]) and high CVH achievement (0.53[0.39-0.73]) after adjusting for age, sex, race/ethnicity and field center ( Table ). These associations attenuated with further adjustment for education and income, to 0.94[0.88-1.02] for medium and 0.68[0.50-0.94] for high CVH. Of individual LS7 metrics, limited HL was significantly associated with high glucose levels. Conclusion: Limited HL was associated with suboptimal overall CVH as well as elevated blood glucose levels independent of education. Clinical trials are needed to assess whether improving health literacy enhances CVH.

LOWER EXTREMITY PHERIPHERALARTERIAL DISEASE - AN UPDATE

Lower-extremity arterial disease (LEAD) is a major endemic disease with an alarming increased prevalence worldwide. It is a common and severe condition with excess risk of major cardiovascular events and death. It also leads to a high rate of lower-limb adverse events and non-traumatic amputation. The American Diabetes Association recommends a widespread medical history and clinical examination to screen for LEAD. The ankle brachial index (ABI) is the first non-invasive tool recommended to diagnose LEAD although its variable performance in patients with diabetes. The performance of ABI is particularly affected by the presence of peripheral neuropathy, medial arterial calcification, and incompressible arteries. There is no strong evidence today to support an alternative test for LEAD diagnosis in these conditions. The management of LEAD requires a strict control of cardiovascular risk factors including diabetes, hypertension, and dyslipidaemia. The benefit of intensive versus standard glucose control on the risk of LEAD has not been clearly established. Antihypertensive, lipid-lowering, and antiplatelet agents are obviously worthful to reduce major cardiovascular adverse events, but few randomised controlled trials (RCTs) have evaluated the benefits of these treatments in terms of LEAD and its related adverse events. Smoking cessation, physical activity, supervised walking rehabilitation and healthy diet are also crucial in LEAD management. Several advances have been achieved in endovascular and surgical revascularization procedures, with obvious improvement in LEAD management. The revascularization strategy should take into account several factors including anatomical localizations of lesions, medical history of each patient and operator experience. Further studies, especially RCTs, are needed to evaluate the interest of different therapeutic strategies on the occurrence and progression of LEAD and its related adverse events in patients with diabetes.

Arteriographic patterns of peripheral arterial disease in lower limbs in a Peruvian cohort of patients.

There is currently no universal and uniform pattern of peripheral arterial disease (PAD) in the lower limbs; however, it is influenced by various cardiovascular factors of the individual. The objective of this study was to identify the arteriographic patterns of PAD in the lower limbs according to cardiovascular factors in a Peruvian cohort of patients. This is an analytical, observational, and retrospective study. The arteriographic patterns of PAD in the aortoiliac segment were analyzed with the TransAtlantic InterSociety Consensus (TASC-II) score and the Global Anatomic Staging System (GLASS) for the femoropopliteal (FP), infraopopliteal (IP), and pedial (P) segments in a Peruvian cohort from January 2018 to May 2021. 595 patients (833 extremities) were analyzed with a mean age of 67.54 ± 16.39years, and the main cardiovascular factor was diabetes (65.04%). The patients older than 65years with GLASS FP 4 (p = 0.042), IP 0 (p = 0.004), and P2 (p = 0.047) presented significant findings: in men and women with GLASS IP 4 (p = 0.031) and P 2 (p = 0.045); diabetes with TASC-II A (p = 0.031), GLASS FP 4 (p = 0.038), IP 4 (p = 0.009), and P2 (p = 0.003); dyslipidemia with TASC-II D (p = 0.027), GLASS FP 4 (p = 0.038), IP 0 (p = 0.009), and P0 (p = 0.003); smoking with TASC-II D (p = 0.001), GLASS FP 4 (p = 0.049) and IP 0 (p = 0.008); chronic coronary disease with GLASS IP 4 (p = 0.049) and P2 (p = 0.037); chronic kidney disease with GLASS FP 4 (p=0.047), IP 4 (p = 0.004), and P2 (p = 0.016); and previous amputation history with GLASS IP 4 (p = 0.015) and P2 (p = 0.039). The most frequent arteriographic pattern of PAD in the lower limbs of our cohort was TASC-II A, GLASS FP 0 and 4, IP 0, and P2 (p = 0.047). Our work will allow the limb salvage teams to understand the behavior of PAD affectation in the population of our environment, allowing a timely control of cardiovascular risk factors, adequate revascularization planning, and a significant reduction in the risk of loss of limb.

Evaluación de conocimientos, barreras y actitudes en el manejo de la diabetes tipo 2 en pacientes de edad avanzada: estudio Delphi en atención primaria y hospitalaria

ObjectivesThis work aims to explore attitudes regarding the management of elderly or frail patients with type 2 diabetes mellitus in the routine clinical practice of a multidisciplinary group of physicians in Spain. MethodsA mixed survey was used that included both Delphi and opinion, attitude, and behaviour (OAB) questions. Perceptions in primary care (n=211) and hospital care (n=80) were compared. ResultsConsensus was obtained on all statements. Eighty-seven percent of participants considered that severe psychiatric disorders conditioned antidiabetic treatment and 72% that a psychocognitive assessment is as relevant as the assessment of other comorbidities. Hospital care physicians more frequently considered that comorbidity affects self-care (95.0% vs. 82.9%), that a lack of de-intensification is a form of therapeutic inertia (88.8% vs. 76.3%), that classifying older adults as frail is fundamental to choosing targets (96.3% vs. 87.7%), that de-intensification of antidiabetic treatment and control of cardiovascular risk factors should be considered in those over 80 years of age (90.0% vs. 78.7%), and that type 2 diabetes mellitus predisposes patients to sarcopenia (86.3% vs. 71.6%). The usefulness of clinical guidelines was more highly valued among primary care participants (79.1% vs. 72.5%). ConclusionsThere is room for improvement on several aspects of managing elderly or frail patients with type 2 diabetes mellitus, including inertia in treatment de-intensification, conducting a psychocognitive assessment, or the identification of frailty and sarcopenia.

Progress and prospects of therapeutic vaccines for cardiovascular diseases

<p indent=0mm>Effective prevention and treatment of cardiovascular risk factors such as hypertension, hyperlipidemia and diabetes reduce the risk of cardiovascular death. However, the rates of awareness, treatment and control for cardiovascular risk factors in China are still low. Prevention and treatment of cardiovascular diseases is facing huge challenges and difficulties. To explore safe and effective therapeutic methods for cardiovascular diseases and improve treatment compliance, our team has worked hard for long in the field of therapeutic vaccines for cardiovascular diseases, which makes us full of hope for the application prospects of therapeutic vaccines. This article will systematically introduce the research progress in the field of therapeutic vaccines for hypertension, hyperlipidemia and diabetes, clarify the immune response mechanism of peptide-conjugated vaccines and the biased mechanism of ATRQβ-001 hypertension vaccines, aiming to promote basic research and clinical translation in the field of therapeutic vaccines and make therapeutic vaccines an important weapon for the prevention and treatment of cardiovascular diseases soon.

HbA1c, Coronary atheroma progression and cardiovascular outcomes

Background and aimsWe tested the hypothesis that on-treatment HbA1c levels independently associate with coronary atheroma progression and major adverse cardiovascular events (MACE: death, myocardial infarction, cerebrovascular accident, coronary revascularization, or hospitalization for unstable angina) rates. MethodsWe performed a post-hoc pooled analysis of data from seven prospective, randomized trials involving serial coronary intravascular ultrasonography (IVUS). The percent atheroma volume (PAV) was calculated as the proportion of the entire vessel wall occupied by atherosclerotic plaque. Using multivariable mixed modeling, we determined the association of on-treatment HbA1c with annualized change in PAV. Cox proportional hazard models were used to assess the association of HbA1c with incidence of MACE. ResultsAmong 3,312 patients (mean age 58.6±9years, 28.4%women) average on-treatment HbA1c was 6.2±1.1%. Overall, there was no net significant annualized change in PAV (0.12±0.19%, p = 0.52). In a fully adjusted multivariable analysis (following adjustment of age, sex, body mass index, systolic blood pressure, smoking, low- and high-density lipoprotein cholesterol, triglyceride levels, peripheral vascular disease, trial, region, and baseline PAV), higher on-treatment HbA1c levels were independently associated with annualized changes in PAV [beta-estimate (95% confidence interval): 0.13(0.08, 0.19), p < 0.001]. On-treatment HbA1c levels were independently associated with MACE [hazard ratio (95% confidence interval): 1.13(1.04, 1.23), p = 0.005]. ConclusionsIndependent of achieved cardiovascular risk factor control, greater HbA1c levels significantly associate with coronary atheroma progression rates and clinical outcomes. These results support the notion of a direct, specific effect of glycemic control upon coronary atheroma and atherosclerotic events, supporting the rationale of therapies designed to directly modulate it.

Variability in Cardiovascular Risk Factor Control in Patients with Heart Failure According to Gender and Socioeconomic Status.

Background: Despite considerable evidence concerning heart failure (HF) risk factors, there is scarce information about the effect and degree of control regarding socioeconomic and gender inequalities. Methods: Cohort study including HF patients >40 years of age attended in 53 primary health care centers in Barcelona (Spain). Socioeconomic status (SES) was determined by an aggregated deprivation index (MEDEA) according to the neighborhood of residence. Logistic multivariable regression was performed to analyze differences in cardiovascular risk factor control, stratifying by SES and sex. Results: A total of 8235 HF patients were included. Mean age was 78.1 (standard deviation 10.2) years, and 56.0% were women. The most prevalent cardiovascular risk factors were hypertension, diabetes, and dyslipidemia. Blood pressure was the worst controlled factor in both genders with the lowest SES (odds ratio [OR] 0.56 95% confidence interval [CI] 0.56-0.71) and (OR 0.52, 0.46-0.71), respectively. In women, a social gradient was observed for glycemic and body mass index control, which were worse in the most unfavorable socioeconomic position (OR 0.54, 95% CI 0.38-0.77), and (OR 0.45, 95% CI 0.32-0.64), respectively. Men presented worse control of blood pressure (OR 0.55, 95% CI 0.42-0.71) and smoking habit (OR 0.67, 95% CI 0.47-0.90) in the most deprived socioeconomic bracket. Conclusion: Patients with HF in the most disadvantaged socioeconomic levels presented the worst degree of control for cardiovascular risk factors, and this negative effect was stronger in women.

Inflammation as A Precursor of Atherothrombosis, Diabetes and Early Vascular Aging.

Vascular disease was for a long time considered a disease of the old age, but it is becoming increasingly clear that a cumulus of factors can cause early vascular aging (EVA). Inflammation plays a key role in vascular stiffening and also in other pathologies that induce vascular damage. There is a known and confirmed connection between inflammation and atherosclerosis. However, it has taken a long time to prove the beneficial effects of anti-inflammatory drugs on cardiovascular events. Diabetes can be both a product of inflammation and a cofactor implicated in the progression of vascular disease. When diabetes and inflammation are accompanied by obesity, this ominous trifecta leads to an increased incidence of atherothrombotic events. Research into earlier stages of vascular disease, and documentation of vulnerability to premature vascular disease, might be the key to success in preventing clinical events. Modulation of inflammation, combined with strict control of classical cardiovascular risk factors, seems to be the winning recipe. Identification of population subsets with a successful vascular aging (supernormal vascular aging—SUPERNOVA) pattern could also bring forth novel therapeutic interventions.

Control of Cardiovascular Risk Factors in Patients with Chronic Obstructive Pulmonary Disease.

Rationale: Cardiovascular disease accounts for one-third of deaths in patients with chronic obstructive pulmonary disease (COPD). Better control of cardiovascular risk factors in primary care could improve outcomes. Objectives: To define the prevalence, monitoring, treatment, and control of risk factors in patients with COPD. Methods: Repeated cross-sectional analysis of primary care electronic medical records for all patients with COPD in the Canadian Primary Care Sentinel Surveillance Network from 2013 to 2018 (n = 32,695 in 2018). A control group was matched 1:1 for age, sex, and rural residence (n = 32,638 in 2018). Five risk factors were defined using validated definitions including laboratory results: hypertension, dyslipidemia, diabetes, obesity, and smoking. Results: All risk factors were more common in patients with COPD compared with matched control subjects, including hypertension (52.3% vs. 44.9%), dyslipidemia (62.0% vs. 57.8%), diabetes (25.0% vs. 20.2%), obesity (40.8% vs. 36.8%), and smoking (40.9% vs. 11.4%), respectively. The mean Framingham risk score was 20.6% versus 18.6%, with 53.8% of patients with COPD being high risk (⩾20%). Monitoring of risk factors within the last year in patients with COPD in 2018 was suboptimal: 71.8% hypertension, 39.4% dyslipidemia, 74.5% diabetes, 52.3% obesity. Smoking status was infrequently recorded in the electronic record. In those monitored, guideline recommended targets were achieved in 60.8%, 46.6%, 57.4%, 10.6% and 12.0% for each risk factor. Cardiovascular therapies including angiotensin-converting enzyme inhibitors (69%), statins (69%), and smoking cessation therapies (27%) were underused. Conclusions: In patients with COPD, major cardiovascular risk factors are common, yet inadequately monitored, undertreated, and poorly controlled. Strategies are needed to improve comprehensive risk factor management proven to reduce cardiovascular morbidity and mortality.

Trends in the Degree of Control and Treatment of Cardiovascular Risk Factors in People With Type 2 Diabetes in a Primary Care Setting in Catalonia During 2007-2018.

ObjectiveTo assess the trends in cardiovascular risk factor control and drug therapy from 2007 to 2018 in subjects with type 2 diabetes mellitus (T2DM).Materials and MethodsCross-sectional analysis using yearly clinical data and treatment obtained from the SIDIAP database. Patients aged ≥18 years with a diagnosis of T2DM seen in primary care in Catalonia, Spain. ResultsThe number of T2DM patients increased from 299,855 in 2007 to 394,266 in 2018. We also found an increasing prevalence of cardiovascular disease, heart failure, and chronic kidney disease (from 18.4 to 24.4%, from 4.5 to 7.3%, and from 20.2 to 31.3%, respectively). The achievement of glycemic targets (HbA1c<7%) scarcely changed (54.9% to 55.9%). Major improvements were seen in blood pressure (≤140/90 mmHg: from 55% to 71.8%), and in lipid control (low-density lipoprotein cholesterol <100 mg/dl: 33.4% to 48.4%), especially in people with established cardiovascular disease (48.8 to 69.7%). Simultaneous achievement of all three targets improved from 12.5% to 20.1% in the overall population and from 24.5% to 32.2% in those with cardiovascular disease but plateaued after 2013. There was an increase in the percentage of patients treated with any antidiabetic drug (70.1% to 81.0%), especially metformin (47.7% to 67.7%), and DPP4i (0 to 22.6%). The use of SGLT-2 and GLP-1ra increased over the years, but remained very low in 2018 (5.5% and 2.1% of subjects, respectively). There were also relevant increases in the use of statins (38.0% to 49.2%), renin-angiotensin system (RAS) drugs (52.5% to 57.2%), and beta-blockers (14.3% to 22.7%).ConclusionsDuring the 2007-2018 period, relevant improvements in blood pressure and lipid control occurred, especially in people with cardiovascular disease. Despite the increase in the use of antidiabetic and cardiovascular drugs, the proportion of patients in which the three objectives were simultaneously achieved is still insufficient and plateaued after 2013. The use of antidiabetic drugs with demonstrated cardio renal benefits (SGLT-2 and GLP-1ra) increased over the years, but their use remained quite low.

Cardiovascular risk factor progression in adolescents and young adults with youth-onset type 2 diabetes

AimsYouth-onset type 2 diabetes (T2D) confers a high risk of early adverse cardiovascular morbidity. We describe the cumulative incidence and prevalence of cardiovascular risk factors over time and examine relationships with diabetes progression in young adults with youth-onset T2D from the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study. MethodsLongitudinal data was used to evaluate the relationships between hypertension, LDL-C dyslipidemia, hypertriglyceridemia, and smoking with risk factors in 677 participants. ResultsBaseline mean age was 14 ± 2 years and mean follow-up 10.2 ± 4.5 years. The 14-year cumulative incidence of hypertension, LDL-C dyslipidemia, and hypertriglyceridemia was 59%, 33%, and 37% respectively. Average prevalence of reported smoking was 23%. Male sex, non-Hispanic white race/ethnicity, obesity, poor glycemic control, lower insulin sensitivity, and reduced beta-cell function were significantly associated with an unfavorable risk profile. At end of follow-up, 54% had ≥2 cardiovascular risk factors in addition to T2D. ConclusionsCardiovascular risk factor incidence and prevalence was high over a decade of follow-up in young adults with youth-onset T2D. Glucose control and management of cardiovascular risk factors is critical in youth with T2D for prevention of cardiovascular morbidity and mortality.