Cardiovascular Risk Factors and Adherence to Cardiovascular Protection Practice Guidelines in Adults With Type 1
Houssein Madar1, Marie-Laure Lalanne-Mistrih2, Maha Lebbar3
1Montreal Clinical Research Institute, Montréal, Québec, Canada.
Insights
Most people with type 1 diabetes (PWT1D) receive recommended cardiovascular protection. However, specific subgroups need more attention, and achieving key risk factor targets remains suboptimal for PWT1D.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Cardiovascular disease (CVD) is a leading cause of illness and death in people with type 1 diabetes (PWT1D).
- Assessing cardiovascular risk factors and treatment is crucial for managing PWT1D.
- The BETTER registry provides a valuable dataset for this Canadian cohort.
Purpose of the Study:
- To evaluate cardiovascular risk factors and pharmacologic treatment strategies in a large Canadian cohort of PWT1D.
- To identify subgroups of PWT1D with suboptimal adherence to treatment guidelines.
- To determine the extent of target achievement for key cardiovascular risk factors.
Main Methods:
- Cross-sectional study utilizing data from 974 adult PWT1D in the BETTER registry.
- Self-reported data on CVD risk factors, diabetes complications, and treatments via online questionnaires.
- Objective data available for a subset (23%) of participants.
Main Results:
- A significant proportion of PWT1D reported high cardiovascular risk (67.2%) and multiple risk factors (27.2%).
- While most received guideline-recommended care, 3 subgroups showed lower adherence to Diabetes Canada Clinical Practice Guidelines (DC-CPG).
- Only 24.5% of participants with recent lab data achieved both A1C and LDL cholesterol targets.
Conclusions:
- Most PWT1D benefit from recommended pharmacologic cardiovascular protection.
- Specific subgroups, including those with microvascular complications or longer diabetes duration, require targeted interventions.
- Suboptimal achievement of A1C and LDL cholesterol targets highlights the need for improved risk factor management in PWT1D.
Objectives:
Cardiovascular disease (CVD) is a major cause of morbidity and mortality in people with type 1 diabetes (PWT1D). We assessed cardiovascular risk factors and pharmacologic treatment in a large Canadian cohort of PWT1D.
Methods:
This cross-sectional study used data from adult PWT1D in the BETTER registry (n=974). CVD risk factor status, diabetes complications, and treatments (used as proxy for blood pressure and dyslipidemia) were self-reported through online questionnaires. Objective data were available for a subgroup of PWT1D (23%, n=224).
Results:
Participants were adults (43.9±14.8 years) with a diabetes duration of 23.3±15.2 years; 34.8% reported glycated hemoglobin (A1C) levels of ≤7%, 67.2% reported a very high cardiovascular risk, and 27.2% reported at least 3 CVD risk factors. Most participants received care for CVD in accordance with the Diabetes Canada Clinical Practice Guidelines (DC-CPG), with a median recommended pharmacologic treatment score of 75.0%. However, 3 subgroups of participants with lower adherence (<70%) to DC-CPG were identified: 1) those with microvascular complications and receiving a statin (60.8%, 208 of 342) or renin-angiotensin axis nephroprotective therapy (52.6%, 180 of 342); 2) those aged ≥40 years and receiving statin therapy (67.1%, 369 of 550); and 3) those aged ≥30 years with a diabetes duration of ≥15 years and receiving statin therapy (58.9%, 344 of 584). Among a subgroup of participants with recent laboratory results, only 24.5% of PWT1D (26 of 106) achieved both A1C and low-density lipoprotein cholesterol targets.
Conclusions:
Most PWT1D received recommended pharmacologic cardiovascular protection, but specific subgroups required special attention. Target achievement for key risk factors remains suboptimal.
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