Few Diabetes Patients Achieve ASCVD Risk Factor Targets, NCDR Study Shows

As few as one-fifth of adult diabetes patients are achieving target levels for atherosclerotic cardiovascular disease (ASCVD) prevention risk factors, according to a study published in Diabetes, Obesity and Metabolism.

Using data from ACC and Veradigm's Diabetes Collaborative Registry, Wenjun Fan, MD, et al., investigated target attainment of HbA1c, LDL cholesterol and blood pressure, as well as nonsmoking status, among 74,393 adult patients with diabetes. Target HbA1c was defined as <7 percent and <8 percent, respectively, for patients without and with prior ASCVD. For LDL cholesterol, the target was <100 mg/dL for those without ASCVD and <70 mg/dL for patients with an ASCVD history. Blood pressure was calculated using targets of <140/90 and <130/80, based on the 2017 ACC/AHA Guideline.

Researchers also measured composite scores for all four risk factors (HbA1c, LDL cholesterol, blood pressure and nonsmoking status) and for three risk factors (HbA1c, LDL cholesterol and blood pressure).

Overall, 21.6 percent of all patients met the target levels for the composite of all four risk factors, including 23.6 percent of patients without prior ASCVD and 20.7 percent of those with an ASCVD history. When target blood pressure was set at 130/80, the composite score of four risk factors decreased to 13 percent. When nonsmoking status was excluded, 15.3 percent of all patients achieved composite control of HbA1c, LDL cholesterol and blood pressure.

The researchers conclude that one in five diabetes patients are achieving comprehensive risk factor control for ASCVD prevention, a proportion that decreases to fewer than one in six with the lower blood pressure target. They note that moving forward, optimizing cardiovascular disease prevention will require improved interventions focused on lifestyle management and evidence-based treatments.

Keywords: Cholesterol, LDL, Blood Pressure, Atherosclerosis, Diabetes Mellitus, Hypotension, Registries, National Cardiovascular Data Registries, Diabetes Collaborative Registry, Obesity

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