Abstract 1815: High Prevalence of Cardiovascular Risk Factor Clustering and Suboptimal Treatment among Poor Urban Diabetics
Patients with diabetes often have multiple comorbid cardiovascular (CV) risk factors that interact synergistically to accelerate CV pathogenesis and dramatically increase risk for CV events. The purpose of this analysis was to examine CV risk factor clustering and quality of CV risk factor management among diabetics. Data were collected during baseline evaluation for a randomized trial of multiple risk factor intervention to reduce total CV risk in urban community clinics. CV risk factors were measured directly using standardized procedures. Sociodemographic characteristics, current medications, and medication adherence were obtained via self-report questionnaire. The sample of primary care, diabetic patients (n=138) was 74% female, 89% Black with mean age 55 ± 11 years, 68% had at least high school education, and 60% had annual household income < $20,000. HgA1C was ≥ 7% for 75% and ≥ 9% for 36%. While 50% reported 2 or more diabetes meds, 14% were on no diabetes meds. Only 50% were on an ACE-I or ARB and only 50% were on ASA or other antiplatelet med. Current smoking was reported by 30% with none reporting smoking cessation meds. BMI was ≥ 30 kg/m2 for 73%. BP was uncontrolled (≥130/80 mmHg) for 69%. Of those with uncontrolled BP, 19% were not on antihypertensive medications. LDL was ≥ 100 mg/dl for 58%. Of those with LDL ≥ 100 mg/dl, 57% were not on lipid lowering meds. In addition to diabetes, 42% had at least 2 other CV risk factors. More than one CV risk factor (HgA1C ≥ 7, BP ≥130/80 mmHg, LDL ≥100 mg/dl) was uncontrolled for 22%. Exploratory logistic regression models identified the following significant predictors of risk factor control: HgA1C < 7 [number of diabetes meds (OR .45, 95% CI .28, .74)]; LDL <100 mg/dl [mean medication adherence (OR 1.05, 95% CI 1.01, 1.10) and number of lipid lowering meds (OR 2.5, 95% CI 1.24, 4.82)]; BP <130/80 mmHg (no significant predictors). Despite being in care, this sample of diabetics including predominantly Black women had high prevalence of CV risk factor clustering and management of CV risk factors including diabetes was suboptimal. Multifactorial interventions to manage CV risk factors in this high risk population are needed.