We know that people with type 2 diabetes have an increased risk of cardiovascular (CV) disease, and that it is not just elevated blood sugars that contributes to that risk. A recent study looked at whether the excess CV risk of a person with diabetes could be decreased or eliminated, and if so, how.
The study, published in the New England Journal of Medicine, evaluated over 270,000 people with type 2 diabetes in the Swedish National Diabetes Register, and matched them with controls who did not have diabetes. They looked at deaths, heart attacks, strokes, and hospitalizations for heart failure, and examined the risk associated with the number of cardiovascular risk factors that were outside the target range. They looked at five cardiovascular risk factors:
- Elevated A1C (a marker of diabetes control)
- Elevated LDL (bad) cholesterol
- Albumin in the urine (a complication of diabetes)
- Smoking
- Elevated blood pressure
After a median of 5.7 years, they found that the CV risk decreased for each risk factor that was in the target range. In fact, for people with all of these risk factors in the target range, the risk of stroke or death was not statistically significantly different than controls, and the risk for heart attack was 16% lower than controls.
Diabetes outside of target control range was the strongest predictor of stroke and heart attack; smoking and low physical activity were the strongest predictors of death.
Of note, the risk of hospitalization for heart failure was consistently 45% higher in people with type 2 diabetes compared to controls. We are recognizing in recent years that heart failure is more common in people with diabetes, even if they have never had a heart attack. (more on this in a future blog post)
BOTTOM LINE: Ensuring good control of blood sugars, blood pressure, cholesterol, and not smoking, puts you well on your way to normalizing your risk of cardiovascular events.
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