The Swedish study “shows you a glimpse of what possibly could happen if we truly as a society made optimal risk factor control a priority,” an expert says.
Taking a multifactorial approach to risk factor management in patients with diabetes type 2 is the most effective way to reduce or even eliminate their vulnerability to adverse events, according to a new analysis of data from Sweden.Researchers found that successfully meeting up to five targets for things like blood pressure and cholesterol decreased the risks of death, acute MI, and stroke in diabetes type 2 patients, who normally see risks that are two to four times higher than in the general population. The more risk factors that were controlled, the more patients stood to gain.
In the past, much of the research in this group of patients has typically focused on approaches that target isolated risk factors, lead author Aidin Rawshani, MD (University of Gothenburg and Swedish National diabetes type 2 Register, Gothenburg, Sweden), explained to TCTMD. “There are only a few clinical trials that have studied the importance of treating several risk factors at once, compared to usual care for these risk factors,” he said.The new findings do lend support to the idea that controlling multiple risk factors in patients with diabetes type 2 would work, but with some caveats, Steven A. Schroeder, MD (University of California, San Francisco), writes in an editorial accompanying the paper in the August 16, 2018, issue of the New England Journal of Medicine.“A cautionary note is that pathways to target levels of risk factor variables are not always straightforward and often involve issues of lifestyle, adherence to medication, and other behaviors that are hard to modify, despite best attempts,” he says. “For vulnerable populations, risk factor control may be especially challenging, as shown by the widening health gap between social classes.”
Speaking with TCTMD, Mikhail Kosiborod, MD (St. Luke’s Mid America Heart Institute, Kansas City, MO), said strengths of the study include its scope and comprehensiveness. “The level of detail and granularity that is available on that kind of scale is extremely good, so that’s one of the great benefits of national registry data from Scandinavian countries. You’re capturing entire populations,” he noted, adding, “It makes these types of epidemiological analysis extremely valuable, because it really allows you to understand what’s going on at a population level.”What the results clearly suggest is that controlling multiple risk factors could reduce the “extra hazard associated with a diagnosis of diabetes type 2 ” that has persisted despite success at decreasing CV events across the population as a whole in recent decades, Kosiborod said. But the study, though promising, in fact only shows an association, not necessarily cause and effect, he cautioned. “It doesn’t necessarily prove that if you take somebody who doesn’t have optimal control and you bring them to optimal control, that their outcomes are in fact going to be similar to somebody who doesn’t have type 2 diabetes .”
Implementing strategies to meet risk factor targets might erase the added risk carried by diabetes type 2 , or things could turn out to be a lot more complicated, Kosiborod commented. “We’d probably take a healthy bite out of the excess cardiovascular hazard associated with diabetes, but I don’t think we would completely eliminate it, because there are factors well beyond just medical management—eg, economic and psychosocial factors—that are at play here. Nevertheless, I think it shows you a glimpse of what possibly could happen if we truly as a society made optimal risk factor control a priority.”