Key result
Optimal risk factor control is linked to normalized mortality in T2D only without prior CVD.
Why the study?
The extent to which optimal control of traditional cardiovascular risk factors reduces excess all-cause mortality risk in individuals with type 2 diabetes was unclear.
Does optimal control of traditional cardiovascular risk factors reduce all-cause mortality in individuals with type 2 diabetes?
Cohort (n=15,773)
Yes
Does optimal control of traditional cardiovascular risk factors reduce all-cause mortality in individuals with type 2 diabetes?
Optimal control of cardiovascular risk factors eliminates excess mortality in type 2 diabetes patients without prior cardiovascular disease, but overtreatment should be avoided.
Supports risk factor optimization in T2D without prior CVD; hypothesis-generating for secondary prevention and requires RCT confirmation before practice change.
Aims To assess whether and to what extent excess risk of all-cause death is reduced in individuals with type 2 diabetes by achieving optimal control of traditional cardiovascular risk factors. Methods This observational, prospective, cohort study enrolled 15,773 Caucasian patients in 19 Italian centres in 2006–2008. Participants were stratified according to the number of the following risk factors outside target: haemoglobin A 1c , blood pressure, micro/macroalbuminuria, current smoking, LDL cholesterol, and triglycerides. All-cause mortality was retrieved for 15,656 patients (99.3 %) on 31 October 2015. Results Age-adjusted mortality rates and hazard ratios were significantly higher in the whole RIACE cohort (by ∼20 %) and in patients with (by ∼100 %) but not in those without prior cardiovascular disease (CVD), as compared with the coeval Italian general population. In all patients and in those without prior CVD, the relationship with mortality according to the number of risk factors outside target was J-shaped, an effect that was attenuated after either excluding "overtreated " patients, i.e., those with haemoglobin A 1c ≤6.0 % on anti-hyperglycaemic agents causing hypoglycaemia and/or systolic blood pressure ≤120 mmHg on anti-hypertensive agents, or adjusting for "overtreatment". Conversely, in patients with prior CVD, mortality remained higher than in the general population in all categories and increased progressively from +70 % to +314 %, without J-effect. Conclusions In patients with type 2 diabetes, optimal treatment of traditional cardiovascular risk factors completely eliminated the excess mortality risk versus the general population, provided that they were not "overtreated". However, this effect was observed only in participants without history of CVD. Trial registration ClinicalTrials.gov, NCT00715481, retrospectively registered 15 July 2008.
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Garofolo et al. (2024) conducted a cohort in Type 2 diabetes (n=15,773). Suboptimal control of traditional cardiovascular risk factors vs. Optimal control of traditional cardiovascular risk factors / general population was evaluated on All-cause mortality. Optimal risk factor control eliminated excess mortality risk versus the general population in type 2 diabetes patients without prior CVD, but not in those with prior CVD (+70% to +314% mortality).