Controlling multiple risk factors lowers CAD risk in diabetic patients

Achieving multifactorial targets for blood pressure (BP), low-density lipoprotein-cholesterol (LDL-C), HbA1c and current smoking greatly benefits patients with and without diabetes mellitus (DM) and is associated with a reduced risk for coronary artery disease (CAD), a study has shown.

This prospective cohort study used a nationwide claims database of 220,894 individuals in Japan to examine the effects of the number of controlled risk factors among BP, LDL-C, HbA1c and current smoking on subsequent CAD. Risks over a follow-up of 4.8 years were examined using Cox regression.

Of the participants, the largest percentage had two risk factors at target in patients with (39.6 percent) and without DM (36.4 percent). Regardless of the presence of DM, the risks of CAD were two- and fourfold higher among persons who had achieved any one and no target, respectively, as compared to those who had achieved two targets.

Composite control of modifiable risk factors in patients with DM reduced the risk of CAD below that for those without DM with any two targets achieved. On the other hand, the risk of CAD in the DM group with all four risk factors uncontrolled was 9.4 times higher than that in the non-DM group who had achieved two targets.

“These findings show that composite control of modifiable risk factors has a large effect in patients with and without DM,” the authors said. “The effect was sufficient to bring CAD risk in patients with DM below that in the non-DM group who had two targets achieved.”