Mortality and cardiovascular disease burden of uncontrolled diabetes in a registry-based cohort: the ESCARVAL-risk study.

BACKGROUND: Despite the epidemiological evidence about the relationship between diabetes, mortality and cardiovascular disease, information about the population impact of uncontrolled diabetes is scarce. We aimed to estimate the attributable risk associated with HbA1c levels for all-cause mortality and cardiovascular hospitalization. METHODS: Prospective study of subjects with diabetes mellitus using electronic health records from the universal public health system in the Valencian Community, Spain 2008-2012. We included 19,140 men and women aged 30 years or older with diabetes who underwent routine health examinations in primary care. RESULTS: A total of 11,003 (57%) patients had uncontrolled diabetes defined as HbA1c ≥6.5%, and, among those, 5325 participants had HbA1c ≥7.5%. During an average follow-up time of 3.3 years, 499 deaths, 912 hospitalizations for coronary heart disease (CHD) and 786 hospitalizations for stroke were recorded. We observed a linear and increasingly positive dose-response of HbA1c levels and CHD hospitalization. The relative risk for all-cause mortality and CHD and stroke hospitalization comparing patients with and without uncontrolled diabetes was 1.29 (95 CI 1.08,1.55), 1.38 (95 CI 1.20,1.59) and 1.05 (95 CI 0.91, 1.21), respectively. The population attributable risk (PAR) associated with uncontrolled diabetes was 13.6% (95% CI; 4.0-23.9) for all-cause mortality, 17.9% (95% CI; 10.5-25.2) for CHD and 2.7% (95% CI; - 5.5-10.8) for stroke hospitalization. CONCLUSIONS: In a large general-practice cohort of patients with diabetes, uncontrolled glucose levels were associated with a substantial mortality and cardiovascular disease burden.

Renal function and attributable risk of death and cardiovascular hospitalization in patients with cardiovascular risk factors from a registry-based cohort: the Estudio Cardiovascular Valencia-risk study.

BACKGROUND: Information about the attributable risk associated with renal dysfunction in patients with cardiovascular risk factors is lacking. OBJECTIVE: We aimed to estimate the attributable risk associated with chronic kidney disease Epidemiology Collaboration-estimated glomerular filtration rate (eGFR), for all-cause mortality, and cardiovascular hospitalization. DESIGN, SETTING, AND PARTICIPANTS: Prospective study of study participants with cardiovascular risk factors in 2008-2012. We included 52 007 cardiovascular disease-free men and women aged 30 years or older with hypertension, diabetes, or dyslipidemia, who underwent routine health examinations in primary care. RESULTS: A total of 6639 (12.8%) patients had eGFR below 60 ml/min per 1.73 m and among them 1782 (3.4%) had 45 ml/min per 1.73 m or lower. During an average follow-up time of 3.2 years, 54.12 deaths, 99.98 coronary heart disease (CHD) hospitalizations, and 90.64 stroke hospitalizations/10 000 person-years were recorded. The population attributable risks associated with having a GFR lower than 60 ml/min per 1.73 m were 6.9% (95% confidence interval = 2.07, 10.65) for all-cause mortality, 6.8% (4.3, 9.4) for CHD hospitalization, and 4.1% (1.02, 7.00) for stroke hospitalization. Participants with increasing number of cardiovascular risk factors displayed increasing population attributable risks associated to a GFR less than 60 ml/min per 1.73 m for all-cause mortality and CHD (P heterogeneity 0.002 and 0.05, respectively). CONCLUSION: In a large general practice cohort of patients with cardiovascular disease risk factors, decreasing eGFR levels were associated with additional attributed risk of mortality and cardiovascular disease. Our findings underscore that intensified efforts are needed to reduce the cardiovascular disease burden associated to chronic kidney disease.

Impact of hypertension on mortality and cardiovascular disease burden in patients with cardiovascular risk factors from a general practice setting: the ESCARVAL-risk study.

OBJECTIVE: To estimate the attributable risk associated to hypertension for all-cause mortality and cardiovascular hospitalization endpoints in a prospective study of patients with at least one cardiovascular risk factors participating in the Estudio Cardiovascular Valencia-risk project, we also evaluated the attributable risk associated with other risk factors and risk factor clustering. METHODS: Prospective electronic health recording-based study in a Mediterranean population that included 52 007 cardiovascular disease-free men and women aged 30 years or older (mean age 62.6 year) with hypertension (79.0%), diabetes mellitus (37.3%), or dyslipidemia (88.2%), who underwent routine health examinations. All-cause mortality and hospitalization records for coronary heart disease (CHD) or stroke were collected. RESULTS: During an average follow-up time of 3.2 years, 928 deaths and 1682 and 1529 hospitalizations for CHD and stroke, respectively, were recorded. In both men and women, hypertension significantly increased the multiadjusted rates of death and CHD and stroke hospitalizations. Hypertension was associated with a substantial amount of avoidable deaths both in men and women, population attributable risks were 41.81 (95% confidence interval 28.02, 53.24)% and 37.84 (5.74, 61.51)%, respectively. Similarly, the population attributable risk of hospitalization for CHD and stroke associated to hypertension was among the highest in both the sexes as compared with the impact of the other main cardiovascular risk factors. Increasing cardiovascular risk factors clustering was associated with increasing burden of disease. CONCLUSION: Our results highlight the relevance of hypertension as main risk factor for mortality and cardiovascular events in a real-life setting. Although our data support the ongoing need of cardiovascular risk factors prevention, intensified actions for primary prevention of hypertension show potential to largely reduce the burden of cardiovascular disease.