Meeting Two Treatment Goals Significantly Reduces CVD Risk

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NEW ORLEANS — Veterans with diabetes who met treatment goals for both HbA1c and LDL cholesterol significantly reduced their risk for microvascular complications, acute coronary syndromes, percutaneous coronary intervention and coronary artery bypass graft compared with those who met only one of those goals.

That’s according to a recent study that looked at the clinical and economic benefits associated with dual-goal achievement, defined as HbA1c under 7% and LDL cholesterol (LDL-C) at less than 100 mg/dL.1

Compared with reaching only the A1c goal, dual-achievement was associated with a lower risk for coronary artery bypass graft and the composite cardiovascular endpoint, according to the study published in Diabetes Care.

Diabetes-related medical service costs were significantly lower for dual-goal, LDL cholesterol, and A1c achievers compared with those who did not achieve either goal, according to the study led by researchers from Tulane University in New Orleans.

For the retrospective cohort analysis, researchers evaluated electronic medical records from VISN 16 for more than 75,000 type 2 diabetes patients with two or more measurements of LDL-C and HbA1c between January 2004 and the end of June 2010.

Study subjects were an average of 65 years old — 97% were men, and 67% were white. Achievement of both LDL cholesterol and A1c goals occurred in about 35% of participants. While 22% achieved only the LDL cholesterol goal, 25% achieved only the A1c goal, and 19% achieved neither goal, according to the report.

Researchers assessed diabetes-related resource utilization (i.e., hospitalization days and number of outpatient visits) and medical service costs.

The study found that, compared with achievement of only the LDL-C goal, dual-goal achievement was associated with lower risk of microvascular complications (adjusted hazard ratio [aHR] 0.79), acute coronary syndrome (0.88), percutaneous coronary intervention (0.78) and coronary artery bypass graft (CABG) (0.74). Meeting both treatment goals also was associated with fewer hospitalization days (adjusted incidence rate ratio [aIRR] 0.93) and outpatient visits (0.88), as well as lower diabetes-related annual medical costs (-$130.89).

Compared with achievement of only the HbA1c goal, dual-goal achievement was associated with lower risk of the composite cardiovascular-related endpoint (aHR 0.87) and CABG (aHR 0.62), as well as fewer outpatient visits (aIRR 0.98).

“Achieving both HbA1c and LDL-C goals in diabetes care is associated with additional clinical and economic benefits, as compared with the achievement of either goal alone,” the study authors wrote.

1Shi L, Ye X, Lu M, Wu EQ, Sharma H, Thomason D, Fonseca VA. Clinical and economic benefits associated with the achievement of both HbA1c and LDL cholesterol goals in veterans with type 2 diabetes. Diabetes Care. 2013 Oct;36(10):3297-304. doi: 10.2337/dc13-0149. Epub 2013 Jun 25. PubMed PMID: 23801723; PubMed Central PMCID: PMC3781519.

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