Related Experiment Video
Updated: Feb 10, 2026
Fundus Photography as a Convenient Tool to Study Microvascular Responses to Cardiovascular Disease Risk Factors in Epidemiological Studies
Published on: October 22, 2014
Multiple risk factor control, mortality and cardiovascular events in type 2 diabetes and chronic kidney disease: a
Shota Hamada1,2, Martin C Gulliford1,3
1Department of Primary Care and Public Health Sciences, King's College London, London, UK.
Insights
Multiple risk factor control (MRFC) significantly reduces mortality and cardiovascular events in patients with diabetes and chronic kidney disease (CKD). Achieving four control criteria offers substantial protection against these adverse outcomes.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Endocrinology
Background:
- Diabetes and chronic kidney disease (CKD) significantly increase risks for mortality and cardiovascular events.
- Effective management strategies are crucial for this high-risk population.
Purpose of the Study:
- To evaluate the effectiveness of multiple risk factor control (MRFC) in reducing mortality and cardiovascular events in patients with type 2 diabetes and CKD.
- To assess the association between the number of controlled risk factors and adverse outcomes.
Main Methods:
- Population-based cohort study using UK primary care data linked with inpatient and mortality records.
- Included 11,431 participants with CKD and 36,429 without CKD, aged 40-79 years.
- MRFC included HbA1c, blood pressure, total cholesterol, and smoking status.
Main Results:
- Increasing adherence to MRFC criteria was associated with lower hazards for all-cause mortality, cardiovascular mortality, coronary heart disease, and stroke.
- Participants with CKD meeting four MRFC criteria had a 40% lower risk of all-cause mortality (HR 0.60) and cardiovascular mortality (sHR 0.60).
- Significant risk reductions were also observed for coronary heart disease (sHR 0.73) and stroke (sHR 0.63) in those meeting four criteria.
Conclusions:
- MRFC demonstrates potential in mitigating the elevated risks of mortality and cardiovascular events in individuals with diabetes and CKD.
- Further research is warranted to personalize MRFC strategies based on individual patient health status for optimal cardiovascular risk management.
Objectives:
This study aimed to evaluate the effectiveness of multiple risk factor control (MRFC) at reducing mortality and cardiovascular events in diabetes and chronic kidney disease (CKD) in clinical practice.
Design:
Population-based cohort study.
Setting:
Primary care database in the UK, linked with inpatient and mortality data.
Participants:
Participants aged 40-79 years with type 2 diabetes and valid serum creatinine measurements, including 11 431 participants with CKD (estimated glomerular filtration rate: eGFR 15-59 mL/min/1.73 m2) and 36 429 participants with non-CKD (eGFR ≥60 mL/min/1.73 m2).
Exposures:
MRFC consisted of four components: Haemoglobin A1c (HbA1c) <53 mmol/mol (<7.0%), blood pressure <140/90 mm Hg, total cholesterol <5 mmol/L and no smoking. The main exposure variable was the number of risk factors controlled at baseline.
Outcome Measures:
All-cause and cardiovascular mortality in the overall participants. Cardiovascular events, including coronary heart disease and stroke, in participants limited to those without a history of cardiovascular diseases at baseline.
Results:
In participants with CKD, 37% or 13% met three or four MRFC criteria, respectively. Increasing numbers of risk factors controlled were associated with lower relative hazards for all outcomes studied compared with those meeting no or one criterion. For participants with CKD meeting four criteria, the adjusted HR for all-cause mortality was 0.60 (95% CI 0.53 to 0.69) and the adjusted subdistribution HR for cardiovascular mortality was 0.60 (95% CI 0.50 to 0.70), considering a competing risk of non-cardiovascular death. Participants meeting four criteria also had lower relative hazards for coronary heart disease (adjusted subdistribution HR 0.73, 95% CI 0.59 to 0.91) and stroke (0.63, 95% CI 0.45 to 0.89), considering death as a competing risk.
Conclusions:
MRFC may lower the increased risks for mortality and cardiovascular events in people with diabetes and CKD. Further research is needed to evaluate appropriateness of MRFC according to individual participants' health status for improved management of cardiovascular risks in this population.
More Related Videos
06:50A High-Throughput Electrochemiluminescence 7-Plex Assay Simultaneously Screening for Type 1 Diabetes and Multiple Autoimmune Diseases
Published on: May 29, 2020
07:51Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis
Published on: September 26, 2018
Related Concept Videos
01:25Chronic Kidney Disease I: Introduction
01:22Diabetes Mellitus: Type 2 and Gestational
01:24Chronic Kidney Disease II: Clinical Manifestations
01:28Chronic Kidney Disease III: Interprofessional Care
01:18Chronic Kidney Disease IV: Nursing Management
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...