Abstract 16183: Preventable Coronary Heart Disease Events from Optimal Control of Cardiovascular Risk Factors in US Adults with Diabetes

Abstract

Background. Type 2 diabetes (DM) carries significant risks for coronary heart disease (CHD). While the control of individual risk factors has been shown to reduce CHD events in DM, the impact of composite risk factor control on the population has not been previously described.

Methods. Among US adults with DM in the National Health and Nutrition Examination Survey (NHANES) 2007-2008 diagnosed age >30 years (NHANES cutpoint for type 2 DM), we assessed the proportion of CHD events preventable using the United Kingdom Prospective Diabetes Study CHD risk engine, with estimates weighted to the US population. We examined the impact of control of total cholesterol (TC), high-density lipoprotein (HDL)-cholesterol, systolic blood pressure (SBP), and glycated hemoglobin (HbA1c) in all those not controlled to goal. “All to Goal” control was defined as a TC to 170 mg/dl, HDL-C to 40 mg/dl for men and 50 mg/dl for women, SBP to 130 mmHg and HbA1c to 7.0%; “Nominal Control” was a 25% reduction in TC, 10% increase in HDL-C, 10% decrease in SBP, and a 1% absolute decrease in HbA1c; “Aggressive Control” was defined as changes of -50%, +20%, -20%, and -2%, respectively. Preventable CHD events were obtained by subtracting the number of events obtained from the control of these risk factors from the number from using current risk factor levels.

Results. Of 196 (representing 4.6 million) males and 188 (4.9 million) females with DM and no prior CHD, 1.1 million males and 0.6 million females would develop CHD events within 10 years if left uncontrolled. Controlling all risk factors to goal was estimated to prevent 32% and 39% of CHD events in males and females, respectively. Nominal risk factor control prevented 29% and 34% and aggressive control 50% and 57% of CHD events, respectively (Table).

Conclusions. Many CHD events in US adults could be prevented from composite control of lipids, blood pressure, and A1c. Attention should be given to composite risk factor goal attainment many do not currently achieve.