Preventable Major Cardiovascular Events Associated With Uncontrolled Glucose, Blood Pressure, and Lipids and Active Smoking in Adults With Diabetes With and Without Cardiovascular Disease: A Contemporary Analysis
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- Gabriela Vazquez-Benitez
- HealthPartners Institute for Education and Research, Minneapolis, MN
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- Jay R. Desai
- HealthPartners Institute for Education and Research, Minneapolis, MN
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- Stanley Xu
- Kaiser Permanente Institute for Health Research, Denver, CO
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- Glenn K. Goodrich
- Kaiser Permanente Institute for Health Research, Denver, CO
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- Emily B. Schroeder
- Kaiser Permanente Institute for Health Research, Denver, CO
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- Gregory A. Nichols
- Kaiser Permanente Center for Health Research, Portland, OR
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- Jodi Segal
- Johns Hopkins Medicine, Baltimore, MD
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- Melissa G. Butler
- Kaiser Permanente Georgia, Center for Health Research Southeast, Atlanta, GA
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- Andrew J. Karter
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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- John F. Steiner
- Kaiser Permanente Institute for Health Research, Denver, CO
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- Katherine M. Newton
- Group Health Research Institute, Seattle, WA
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- Leo S. Morales
- University of Washington School of Medicine, Seattle, WA
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- Ram D. Pathak
- Department of Endocrinology, Marshfield Clinic, Marshfield, WI
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- Abraham Thomas
- Lutheran Medical Center, Brooklyn, NY
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- Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
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- H. Lester Kirchner
- Geisinger Health System, Danville, PA
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- Beth Waitzfelder
- Kaiser Permanente Center for Health Research, Honolulu, HI
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- Jennifer Elston Lafata
- Lutheran Medical Center, Brooklyn, NY
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- Renuka Adibhatla
- HealthPartners Institute for Education and Research, Minneapolis, MN
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- Zhiyuan Xu
- HealthPartners Institute for Education and Research, Minneapolis, MN
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- Patrick J. O’Connor
- HealthPartners Institute for Education and Research, Minneapolis, MN
Description
<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>The objective of this study was to assess the incidence of major cardiovascular (CV) hospitalization events and all-cause deaths among adults with diabetes with or without CV disease (CVD) associated with inadequately controlled glycated hemoglobin (A1C), high LDL cholesterol (LDL-C), high blood pressure (BP), and current smoking.</jats:p> </jats:sec> <jats:sec> <jats:title>RESEARCH DESIGN AND METHODS</jats:title> <jats:p>Study subjects included 859,617 adults with diabetes enrolled for more than 6 months during 2005–2011 in a network of 11 U.S. integrated health care organizations. Inadequate risk factor control was classified as LDL-C ≥100 mg/dL, A1C ≥7% (53 mmol/mol), BP ≥140/90 mm Hg, or smoking. Major CV events were based on primary hospital discharge diagnoses for myocardial infarction (MI) and acute coronary syndrome (ACS), stroke, or heart failure (HF). Five-year incidence rates, rate ratios, and average attributable fractions were estimated using multivariable Poisson regression models.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Mean (SD) age at baseline was 59 (14) years; 48% of subjects were female, 45% were white, and 31% had CVD. Mean follow-up was 59 months. Event rates per 100 person-years for adults with diabetes and CVD versus those without CVD were 6.0 vs. 1.7 for MI/ACS, 5.3 vs. 1.5 for stroke, 8.4 vs. 1.2 for HF, 18.1 vs. 40 for all CV events, and 23.5 vs. 5.0 for all-cause mortality. The percentages of CV events and deaths associated with inadequate risk factor control were 11% and 3%, respectively, for those with CVD and 34% and 7%, respectively, for those without CVD.</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Additional attention to traditional CV risk factors could yield further substantive reductions in CV events and mortality in adults with diabetes.</jats:p> </jats:sec>
Journal
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- Diabetes Care
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Diabetes Care 38 (5), 905-912, 2015-02-20
American Diabetes Association
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Details 詳細情報について
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- CRID
- 1361137043463376768
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- ISSN
- 19355548
- 01495992
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- Data Source
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- Crossref