Abstract
Background/Aims To analyze the incidence of major cardiovascular disease(CVD) hospitalization events and all-cause mortality among adults with diabetes with or without cardiovascular disease; and to estimate the proportion of preventable events due to uncontrolled lipids, glucose, blood pressure, and to active smoking.
Methods This was a retrospective cohort study using electronic health records and administrative claims. We included individuals with diabetes from a network of 11 U.S. managed care organizations (SUPREME-DM datalink) from 2005 to 20110. Uncontrolled cholesterol was defined as LDL = 100 mg/dL or HDL = 40 (M)/<50 mg/dL (F), uncontrolled glucose as A1c = 8%, and elevated blood pressure as = 140/90 mmHg. Major CVD hospitalization events were identified based on primary discharge diagnoses from inpatient encounters for myocardial infarction (MI) or acute coronary syndrome (ACS), or congestive heart failure (CHF). Mortality data were derived from State Death Records and National Death Index. Five-year incidence rates and rate ratios were estimated using Poisson regression in multivariable models for individuals with and without diagnoses of CVD. Average attributable fractions were estimated for uncontrolled clinical factors and smoking.
Results The study cohort included more than 800,000 patients with diabetes. Mean age was 59 years (SD = 14), 48% were female, and 46% were White. Thirty-one percent had CVD diagnoses at cohort entry. Five-year event rates (per 100 person years) were 5.1 (MI/ACS), 4.5 (stroke), 7.1 (CHF) and 24.4 for all-cause mortality in patients with CVD; rates were 1.4 (MI/ACS), 1.2 (stroke), 1.0 (CHF) and 5.2 in patients without CVD. Twenty four percent of major CVD hospitalizations and 19% of deaths were attributable to uncontrolled clinical factors and smoking in patients with CVD; for individuals without CVD; 36% of major CVD hospitalizations events and 20% of deaths were similarly attributable to uncontrolled factors.
Conclusions Despite improvements in diabetes care, uncontrolled levels of clinical risk factors and smoking still account for more than 30% of CVD events in a population with diabetes. Additional attention to CVD risk factor control may importantly decrease adverse outcomes.
