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Mortality and Cumulative Cardiovascular Risk Factor Control in Patients with Type 2 Diabetes: A Nationwide

Zenglei Zhang1,2, Chunqi Wang1, Xingyu Zhou1,2

  • 1National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.

European Journal of Preventive Cardiology
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Maintaining control over cardiovascular risk factors significantly lowers mortality in type 2 diabetes (T2D) patients. Continuous management of factors like diet, exercise, and blood pressure is crucial for long-term survival.

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Cardiovascular diseaseCumulative exposureDiabetesMortalityMultiple risk factors

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Area of Science:

  • Cardiology
  • Endocrinology
  • Public Health

Background:

  • Cardiovascular risk factor control is vital for patients with type 2 diabetes (T2D).
  • Most evidence relies on baseline measurements, limiting understanding of dynamic risk factor management.
  • The impact of changes and cumulative control over time on mortality in T2D remains under-investigated.

Purpose of the Study:

  • To investigate the association between changes and cumulative control of cardiovascular risk factors and mortality in T2D patients.
  • To evaluate the long-term impact of sustained versus degraded risk factor control on all-cause and cardiovascular disease (CVD) mortality.

Main Methods:

  • Analysis of 138,193 T2D patients (aged 35-75) from the ChinaHEART project.
  • Assessment of risk factors: smoking, diet, physical activity, blood pressure, cholesterol, glucose, and BMI.
  • Cumulative control measured by time-weighted average (TWA); changes assessed by comparing baseline and follow-up control levels.

Main Results:

  • Higher cumulative control of 6-7 risk factors was associated with significantly lower all-cause mortality (HR: 0.43).
  • Improved risk factor control reduced mortality compared to stable low control (HR: 0.86).
  • Highest quartile of TWA risk factor control showed 47% lower mortality (HR: 0.53) than the lowest quartile.

Conclusions:

  • Sustained and cumulative cardiovascular risk factor control substantially reduces mortality in T2D.
  • Continuous risk factor management is critical for improving survival in T2D patients.
  • Findings emphasize the importance of dynamic, ongoing management of modifiable risk factors.