Value-Based Care in Cardiometabolic Health Dec 2012, Vol 1, No 3 - Cardiometabolic Health
Wayne Kuznar

Los Angeles, CA—More than half of all coronary heart disease (CHD) events in American patients with diabetes could be prevented with optimal control of risk factors, suggested Nathan Wong, PhD, MPH, Professor and Director, Heart Disease Prevention Program at the University of California, Irvine, at the 2012 American Heart Association meeting.

Only approximately 10% of the US population with diabetes has simultaneous control of blood glucose, blood lipids, and blood pressure (BP), said Dr Wong. In his statistical analysis, the proportion of CHD events among adults (aged ≥30 years) diagnosed with preventable diabetes was calculated using the United Kingdom Prospective Diabetes Study (UKPDS) CHD Risk Engine version 1.1. The UKPDS Risk Engine was developed specifically in persons with type 2 diabetes, noted Dr Wong.

The study population consisted of those individuals identified with type 2 diabetes and no preexisting CHD from the US National Health and Nutrition Examination Surveys (NHANES) 2007-2008. The impact of control of total cholesterol, high-density lipo­protein cholesterol (HDL-C), systolic BP, and hemoglobin (Hb) A1c in all patients who are not controlled to goal levels was examined.

Control to goals was defined as simultaneous achievement of the following 4 parameters:

  • Total cholesterol, ≤170 mg/dL
  • HDL-C, ≥40 mg/dL in men; ≥50 mg/dL in women
  • Systolic BP ≤130 mm Hg
  • HbA1c ≤7.0%.

Preventable CHD events were calculated by subtracting the number of events prevented by controlling the 4 CHD risk factors from the number of events before risk factor control.

The overall 10-year baseline risk of the study population was estimated at 18%: 23.6% for men, 12.1% for women.

With control of all 4 risk factors to goal, 53.2% of CHD events could be prevented, said Dr Wong. With only nominal control of these risk factors (ie, a 25% reduction in total cholesterol, a 10% increase in HDL-C, a 10% decrease in systolic BP, and an absolute reduction of 1% in HbA1c), 34.7% of the events would have been prevented.

Control of single risk factors to goal would prevent 8% to 36.2% of events, with total cholesterol being the single most important risk factor to control.

“One third of CHD events could be prevented from just achieving goal levels in risk factors not already at goal in a 10-year period,” Dr Wong pointed out.

One weakness to the analysis is the lack of information on atrial fibrillation in NHANES, he said.

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