All is not equal...or is it? Targeting uncontrolled cardiovascular risk factors in racial and ethnic populations to prevent major cardiovascular events [abstract]
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Background and aims: Despite consistent improvement in cardiovascular (CV) risk factors (RF) over the past decade, uncontrolled, yet modifiable CV RFs remain significant contributors to major
CVD. This study assessed the contribution of uncontrolled CVRFs to potentially preventable major CVD by race, ethnicity, and gender. Materials and methods: Data were from 11 integrated health care systems in the United States for the years 2005-2011. Subjects included 760,971 adults (>20 years) with diabetes enrolled for >6 months during the study period. Poor RF control was classified as LDL-c > 100 mg/dL, HbA1c > 7% (53mmol/mol), BP > 140/90 mmHg, or smoker from electronic health records. Major CV events were from primary hospital discharge diagnoses for myocardial infarction, acute coronary syndrome, stroke, or heart failure. The four major race ethnicity groups were Hispanic and non-Hispanic White, Black, and Asian. Aggregate five-year incidence rates and average attributable fractions (AAF) were estimated using multivariable Poisson regression models for race/ethnicity and gender strata. Results: At baseline, White, Black, Asian, and Hispanic subjects had a mean (SD) age of 61 (13), 57(13), 57(13), and 54(13) years; the percent female was 47.1%, 55.3%, 48.6%, and 49.7%; and a prior history of CVD was 39.3%, 32.4%, 24.2%, and 22.5%, respectively. Mean follow-up was 59 months. HbA1c and LDL-c were uncontrolled in 42-60% of subjects (Table). Five-year major CV event rates per 100 person-years for men and women were 85.8 and 66.6 for Whites, 100.9 and 83.9 for Blacks, 67.0 and 43.0 for Asians, and 83.0 and 59.3 for Hispanics. The percentages of CV events attributable to inadequate RF control for men and women were 13.3% and 18.0% for Whites, 15.4% and 21.3% for Blacks, 19.7% and 8.1% for Asians, and 18.3% and 12.7% for Hispanics, respectively. Within gender, AAF were different across race/ethnicity strata (p<0.01). Conclusion: In this large cohort of adults with diabetes from 11 geographically dispersed U.S health systems, rates of major CV events differed by gender, race, and ethnicity as expected. Yet, excess major CV events due to suboptimal HbA1c, LDL-c, BP, and smoking levels were substantial within each subgroup. Improved CV risk factor control can prevent future CV events across all demographic groups.